Tian Xiahui, Yang Yuelong, Luo Xinyi, Cao Liqi, Zhou Xiaobing, Xu Huanwen, Chen Rui, Luo Ruohong, Liu Hui
Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
Cardiovasc Diagn Ther. 2024 Aug 31;14(4):563-575. doi: 10.21037/cdt-24-63. Epub 2024 Aug 5.
The preoperative predictors of residual or recurrent tricuspid regurgitation (TR) after cone reconstruction (CR) remains unclear in patients with Ebstein anomaly (EA). We aimed to determine the predictive value of right ventricular longitudinal strain, assessed using cardiac magnetic resonance (CMR) imaging, for residual or recurrent TR after CR in patients with EA.
This single-centre, retrospective study analysed data from 48 patients with EA [mean ± standard deviation (SD), age, 35.0±13.6 years; 13 males] who underwent CMR before CR between January 2017 and February 2023. Two-dimensional colour Doppler echocardiography was performed before CR and mid-term (>6 months) after CR to evaluate the degree of TR in patients with EA. Thirty healthy volunteers served as controls. Univariate and multivariate logistic regression analyses were performed to identify CMR predictors of moderate or severe TR >6 months after CR.
Mid-term postoperative results revealed severe, moderate, and mild TR in 8 (17%), 7 (15%), and 33 (69%) patients, respectively. For patients with EA and moderate or severe TR after CR, left ventricular global longitudinal strain (GLS), left ventricular ejection fraction, right ventricular global longitudinal strain (RVGLS), and right ventricular ejection fraction (RVEF) were significantly worse compared to patients with mild TR (all P<0.05). Multivariate logistic regression analyses revealed that RVGLS was independently associated with moderate or severe TR >6 months after CR [odds ratio (OR) 1.193, 95% confidence interval (CI): 1.025-1.388; P=0.02].
RVGLS was a significant predictor of moderate or severe TR >6 months after CR. This finding emphasizes that early and accurate measurement of RV function may help to identify patients at high risk for severe residual or recurrent TR.
在埃布斯坦畸形（EA）患者中，圆锥重建（CR）术后三尖瓣反流（TR）残留或复发的术前预测因素仍不明确。我们旨在确定使用心脏磁共振（CMR）成像评估的右心室纵向应变对EA患者CR术后TR残留或复发的预测价值。
这项单中心回顾性研究分析了2017年1月至2023年2月期间48例EA患者（平均±标准差[SD]，年龄35.0±13.6岁；13例男性）的数据，这些患者在CR术前接受了CMR检查。在CR术前和CR术后中期（>6个月）进行二维彩色多普勒超声心动图检查，以评估EA患者的TR程度。30名健康志愿者作为对照。进行单因素和多因素逻辑回归分析，以确定CR术后>6个月中度或重度TR的CMR预测因素。
术后中期结果显示，分别有8例（17%）、7例（15%）和33例（69%）患者出现重度、中度和轻度TR。对于CR术后出现中度或重度TR的EA患者，与轻度TR患者相比，左心室整体纵向应变（GLS）、左心室射血分数、右心室整体纵向应变（RVGLS）和右心室射血分数（RVEF）明显更差（所有P<0.05）。多因素逻辑回归分析显示，RVGLS与CR术后>6个月中度或重度TR独立相关[比值比（OR）1.193，95%置信区间（CI）：1.025-1.388；P=0.02]。
RVGLS是CR术后>6个月中度或重度TR的重要预测因素。这一发现强调，早期准确测量右心室功能可能有助于识别严重TR残留或复发的高危患者。
