Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy.
Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
J Am Soc Echocardiogr. 2023 Nov;36(11):1154-1166.e3. doi: 10.1016/j.echo.2023.06.014. Epub 2023 Jul 3.
Echocardiographic surrogates of right ventricle-to-pulmonary artery (RV-PA) coupling have been reported to be associated with outcomes in patients with secondary tricuspid regurgitation (STR). However, pulmonary artery systolic pressure (PASP) is difficult to estimate using echocardiography in patients with severe STR. The aim of the present study was to evaluate the predictive power of a surrogate of RV-PA coupling obtained using right ventricular (RV) volumes measured on three-dimensional echocardiography.
One hundred eight patients (mean age, 73 ± 13 years; 61% women) with moderate or severe STR were included.
At a median follow-up of 24 months (interquartile range, 2-48 months), 72 patients (40%) had reached the composite end point of death of any cause and heart failure hospitalization. RV-PA coupling was computed as the ratio between RV forward stroke volume (SV) (i.e., RV SV - regurgitant volume) and RV end-systolic volume (ESV). RV forward SV/ESV was significantly more related to the composite end point than RV ejection fraction (area under the curve, 0.85 [95% CI, 0.78-0.93] vs 0.73 [95% CI, 0.64-0.83], respectively; P = .03). A value of 0.40 was found to best correlate with outcome. On multivariate Cox regression, RV forward SV/ESV, tricuspid annular plane systolic excursion/PASP, and RV free wall longitudinal strain/PASP were all independently associated with the occurrence of the composite end point when added to a group of parameters including STR severity (severe vs moderate), atrial fibrillation, pulmonary arterial hypertension, right atrial volume, RV end-diastolic volume, and RV free wall longitudinal strain. RV forward SV/ESV < 0.40 (HR, 3.36; 95% CI, 1.49-7.56; P < .01) carried higher related risk than RV free wall longitudinal strain/PASP < -0.42%/mm Hg (HR, 3.1; 95% CI, 1.26-7.84; P = .01) and tricuspid annular plane systolic excursion/PASP < 0.36 mm/mm Hg (HR, 2.69; 95% CI, 1.29-5.58; P = .01). RV ejection fraction did not correlate independently with prognosis when added to the same group of variables.
RV forward SV/ESV is associated with the risk for death and heart failure hospitalization in patients with STR.
已有研究表明，右心室-肺动脉（RV-PA）耦联的超声心动图替代指标与继发性三尖瓣反流（STR）患者的结局相关。然而，在严重 STR 患者中，使用超声心动图估计肺动脉收缩压（PASP）较为困难。本研究旨在评估使用三维超声心动图测量右心室（RV）容积获得的 RV-PA 耦联替代指标的预测能力。
共纳入 108 例（平均年龄 73±13 岁，61%为女性）中度或重度 STR 患者。
中位随访时间为 24 个月（四分位距，2-48 个月），72 例（40%）患者达到了任何原因死亡和心力衰竭住院的复合终点。RV-PA 耦联通过 RV 前向收缩量（SV）（即 RV SV-反流量）与 RV 收缩末期容积（ESV）的比值来计算。RV 前向 SV/ESV 与复合终点的相关性明显强于 RV 射血分数（曲线下面积，0.85[95%CI，0.78-0.93] vs 0.73[95%CI，0.64-0.83]；P=0.03）。发现 0.40 是与结果相关性最佳的值。多变量 Cox 回归分析显示，当将 STR 严重程度（重度 vs 中度）、心房颤动、肺动脉高压、三尖瓣环平面收缩位移/PASP 和 RV 游离壁纵向应变/PASP 等参数加入到一组参数中时，RV 前向 SV/ESV、三尖瓣环平面收缩位移/PASP 和 RV 游离壁纵向应变/PASP 与复合终点的发生均独立相关。与 RV 游离壁纵向应变/PASP＜-0.42%/mmHg（HR，3.1；95%CI，1.26-7.84；P=0.01）和三尖瓣环平面收缩位移/PASP＜0.36mm/mm Hg（HR，2.69；95%CI，1.29-5.58；P=0.01）相比，RV 前向 SV/ESV＜0.40（HR，3.36；95%CI，1.49-7.56；P＜0.01）与更高的相关风险相关。当将其与同一组变量相加时，RV 射血分数与预后无独立相关性。
在 STR 患者中，RV 前向 SV/ESV 与死亡和心力衰竭住院风险相关。
