Darweesh Reham Mohamed, Ahmed Dina Mohamed Yousry, Ahmed Kamal Mahmoud, El-Aroussy Wafaa Anwar, Elagha Abdalla Amin
Faculty of Medicine - Cardiovascular Department, Cairo University, Cairo, Egypt.
Medical Research Institute, Alexandria University, Alexandria, Egypt.
Egypt Heart J. 2024 Sep 28;76(1):132. doi: 10.1186/s43044-024-00566-3.
It is widely recognized that the right ventricle plays a significant role in the prognosis of numerous diseases. However, the assessment of right ventricular function (RV) has not been given much attention until recently. This study used speckle-tracking echocardiography (STE) to assess RV functions in ischemic cardiomyopathy (ICM) patients.
This study included 74 patients diagnosed with ischemic cardiomyopathy (ICM) and an ejection fraction (EF) of less than 50%. Although all the selected patients had normal RV systolic function by tricuspid annular plane systolic excursion (TAPSE), a considerable percentage of them had subtle RV systolic dysfunction, which could be identified by right ventricular free wall longitudinal strain (RV FWLS) (36.5%) and right ventricular global longitudinal strain (RV GLS) (55.4%). Moreover, the mean RV FWLS was significantly higher than RV GLS (- 20.4 ± 5.08% vs. - 17.5 ± 6.89%), respectively. Advanced left ventricle (LV) adverse remodeling was associated with subtle RV dysfunction. Using multivariate regression analysis, increased E/e' (p = 0.016, CI 1.135-3.423) and RV myocardial performance index (MPI) (p = 0.007, CI 0.000-0.007) were identified as independent factors of impaired RV FWLS with the greatest effectiveness.
When standard RV measures are normal in patients with ICM, RV systolic strain analysis offers an incremental utility to detect subtle abnormalities in RV function, especially in resource-constrained settings where cardiac magnetic resonance (CMR) is not practical.
右心室在多种疾病的预后中起着重要作用，这一点已得到广泛认可。然而，直到最近，右心室功能（RV）的评估才受到较多关注。本研究采用斑点追踪超声心动图（STE）评估缺血性心肌病（ICM）患者的右心室功能。
本研究纳入了74例诊断为缺血性心肌病且射血分数（EF）小于50%的患者。尽管所有入选患者的三尖瓣环平面收缩期位移（TAPSE）显示右心室收缩功能正常，但其中相当一部分患者存在轻微的右心室收缩功能障碍，可通过右心室游离壁纵向应变（RV FWLS）（36.5%）和右心室整体纵向应变（RV GLS）（55.4%）识别出来。此外，右心室游离壁纵向应变的平均值显著高于右心室整体纵向应变（分别为-20.4±5.08% 与 -17.5±6.89%）。左心室（LV）的晚期不良重塑与轻微的右心室功能障碍相关。通过多变量回归分析，E/e'升高（p = 0.016，CI 1.135 - 3.423）和右心室心肌性能指数（MPI）升高（p = 0.007，CI 0.000 - 0.007）被确定为右心室游离壁纵向应变受损的最有效独立因素。
在ICM患者中，当标准的右心室测量值正常时，右心室收缩应变分析在检测右心室功能的细微异常方面具有额外的作用，特别是在心脏磁共振成像（CMR）不可行的资源受限环境中。
