Knight Cardiovascular Institute, Oregon Health and Science University, Portland (N.A., C.S.B., A.A., L.M., C.M.).
Regina General Hospital, SK, Canada (P.D.).
Circ Heart Fail. 2024 Sep;17(9):e011882. doi: 10.1161/CIRCHEARTFAILURE.124.011882. Epub 2024 Aug 29.
Patients with transposition of the great arteries (TGA) and systemic right ventricle often confront significant adverse cardiac events. The prognostic significance of invasive hemodynamic parameters in this context remains uncertain. Our hypothesis is that the aortic pulsatility index and hemodynamic profiling utilizing invasive measures provide prognostic insights for patients with TGA and a systemic right ventricle.
This retrospective multicenter cohort study encompasses adults with TGA and a systemic right ventricle who underwent cardiac catheterization. Data collection, spanning from 1994 to 2020, encompasses clinical and hemodynamic parameters, including measured and calculated values such as pulmonary capillary wedge pressure, aortic pulsatility index, and cardiac index. Pulmonary capillary wedge pressure and cardiac index values were used to establish 4 distinct hemodynamic profiles. A pulmonary capillary wedge pressure of ≥15 mm Hg indicated congestion, termed wet, while a cardiac index <2.2 L/min per m signified inadequate perfusion, labeled cold. The primary outcome comprised a composite of all-cause death, heart transplantation, or the requirement for mechanical circulatory support.
Of 1721 patients with TGA, 242 individuals with available invasive hemodynamic data were included. The median follow-up duration after cardiac catheterization was 11.4 (interquartile range, 7.5-15.9) years, with a mean age of 38.5±10.8 years at the time of cardiac catheterization. Among hemodynamic parameters, an aortic pulsatility index <1.5 emerged as a robust predictor of the primary outcome, with adjusted hazard ratios of 5.90 (95% CI, 3.01-11.62; <0.001). Among the identified 4 hemodynamic profiles, the cold/wet profile was associated with the highest risk for the primary outcome, with an adjusted hazard ratio of 3.83 (95% CI, 1.63-9.02; <0.001).
A low aortic pulsatility index (<1.5) and the cold/wet hemodynamic profile are linked with an elevated risk of adverse long-term cardiac outcomes in patients with TGA and systemic right ventricle.
大动脉转位（TGA）伴右心系统患者常面临严重的不良心脏事件。在这种情况下，侵入性血流动力学参数的预后意义尚不确定。我们的假设是，主动脉搏动指数和利用侵入性手段进行的血流动力学分析可为 TGA 伴右心系统患者提供预后信息。
本回顾性多中心队列研究纳入了 1994 年至 2020 年期间接受心导管检查的 TGA 伴右心系统成人患者。收集的数据包括临床和血流动力学参数，包括测量和计算值，如肺毛细血管楔压、主动脉搏动指数和心指数。肺毛细血管楔压和心指数值用于确定 4 种不同的血流动力学特征。肺毛细血管楔压≥15mmHg 表示充血，称为湿，而心指数<2.2L/min/m 表示灌注不足，标记为冷。主要结局包括全因死亡、心脏移植或需要机械循环支持的复合终点。
在 1721 例 TGA 患者中，纳入了 242 例有可用侵入性血流动力学数据的患者。心导管检查后的中位随访时间为 11.4 年（四分位距，7.5-15.9 年），心导管检查时的平均年龄为 38.5±10.8 岁。在血流动力学参数中，主动脉搏动指数<1.5 是主要结局的有力预测因子，调整后的危险比为 5.90（95%可信区间，3.01-11.62；<0.001）。在确定的 4 种血流动力学特征中，冷/湿特征与主要结局的风险最高，调整后的危险比为 3.83（95%可信区间，1.63-9.02；<0.001）。
主动脉搏动指数低（<1.5）和冷/湿血流动力学特征与 TGA 伴右心系统患者不良心脏结局的风险增加相关。
