Department of Cardiology, Herlev & Gentofte Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory, University of Copenhagen, Copenhagen, Denmark.
Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Int J Cardiovasc Imaging. 2022 Sep;38(9):1919-1928. doi: 10.1007/s10554-022-02584-1. Epub 2022 Mar 21.
Patients undergoing coronary artery bypass grafting (CABG) face an elevated risk of heart failure (HF) and cardiovascular (CV) death. Detailed myocardial tissue analyses of the right ventricle are now possible and may hold prognostic value in these patients. Accordingly, we aimed to evaluate the usefulness of right ventricular (RV) layer-specific RV free wall strain (RVFWS) for predicting HF and/or CV death. Patients undergoing CABG at Gentofte Hospital from 2006 to 2011 with a preoperative echocardiogram underwent RVWFS analysis. RVFWS was obtained by speckle tracking. The outcome was defined as a composite of HF and/or CV death. Cox proportional hazards regression, Harrell's C-statistics, and competing risk regression were used to assess the prognostic value of RVFWS. Of 317 patients, 30 (9.5%) reached the endpoint at a median follow-up of 3.5 years. The mean age was 67 years, 83% were men, and the mean LVEF was 50%. In univariable analyses, endo-RVFWS (HR 1.08, P < 0.001), mid-RVFWS (HR 1.07, P = 0.002), and epi-RVFWS (HR 1.07, P = 0.004, per 1% absolute decrease) were associated with a higher risk of HF or/and CV death. Furthermore, all three layers remained independently associated with the outcome after multivariable adjustment for baseline clinical and echocardiographic measurements. Low endo-RVFWS was associated with a more than threefold increased risk of the outcome (HR = 3.04 (1.45-6.38) P = 0.003). The same was observed for mid-RVFWS (HR = 3.16 (1.45-6.91) P = 0.004), and epi-RVFWS (HR = 3.00 (1.46-6.17) P = 0.003). In patients undergoing CABG, RVFWS assessed by speckle-tracking is a predictor of adverse outcomes.
接受冠状动脉旁路移植术（CABG）的患者面临心力衰竭（HF）和心血管（CV）死亡的风险增加。现在可以对右心室（RV）进行详细的心肌组织分析，并且这些患者可能具有预后价值。因此，我们旨在评估右心室（RV）层特异性 RV 游离壁应变（RVFWS）预测 HF 和/或 CV 死亡的有用性。2006 年至 2011 年在根特医院接受 CABG 的患者在术前进行了 RVWFS 分析。RVFWS 通过斑点跟踪获得。结果定义为 HF 和/或 CV 死亡的复合终点。Cox 比例风险回归、Harrell 的 C 统计量和竞争风险回归用于评估 RVFWS 的预后价值。在 317 名患者中，有 30 名（9.5%）在中位随访 3.5 年后达到终点。平均年龄为 67 岁，83%为男性，平均 LVEF 为 50%。在单变量分析中，心内膜 RVFWS（HR 1.08，P < 0.001）、心中层 RVFWS（HR 1.07，P = 0.002）和心外膜 RVFWS（HR 1.07，P = 0.004，每 1%绝对减少）与 HF 或/和 CV 死亡的风险增加相关。此外，在对基线临床和超声心动图测量进行多变量调整后，所有三层仍然与结果独立相关。低心内膜 RVFWS 与结局的风险增加三倍以上相关（HR = 3.04（1.45-6.38）P = 0.003）。在心中层 RVFWS（HR = 3.16（1.45-6.91）P = 0.004）和心外膜 RVFWS（HR = 3.00（1.46-6.17）P = 0.003）中也观察到同样的情况。在接受 CABG 的患者中，通过斑点跟踪评估的 RVFWS 是不良结局的预测因子。
