Haruki Kaoru, Suzuki Atsushi, Yoshida Ayano, Ashihara Kyomi, Yamaguchi Junichi, Shiga Tsuyoshi
Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Department of Cardiology, Kindai University, Osaka, Japan.
Heart Vessels. 2025 May;40(5):391-404. doi: 10.1007/s00380-024-02481-8. Epub 2024 Nov 10.
In patients with heart failure (HF) with reduced left ventricular ejection fraction (HFrEF), low tricuspid annular plane systolic excursion (TAPSE) on echocardiography is associated with poor prognosis. The significance of TAPSE changes post-HF treatment among HFrEF patients remains unclear. We evaluated the factors associated with persistently low TAPSE and its prognostic impact in Japanese hospitalized patients with HFrEF. We prospectively examined 260 HFrEF patients from the prospective observational HIJ-HF III study of HF patients hospitalized at Tokyo Women's Medical University between 2015 and 2019. Persistently low TAPSE was defined as TAPSE < 17 mm on both pre- and 1-year post-discharge echocardiography. The primary endpoint of the study was all-cause mortality or re-hospitalization due to HF. Prognosis and characteristics were compared between patients with and without persistently low TAPSE. Using characteristics and echocardiography data, factors associated with persistently low TAPSE were assessed using logistic regression analysis. We identified the prognostic impact of persistently low TAPSE in HFrEF patients using Cox proportional hazards models. Seventy-eight (30%) of the 260 patients had persistently low TAPSE. They had higher New York Heart Association functional class; lower baseline TAPSE and left ventricular ejection fraction; and fewer angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Significant factors associated with persistently low TAPSE included higher brain natriuretic peptide level at 1 year after discharge, lower baseline levels of TAPSE and septal s'. Over a follow-up period of 32 months (range 12-69 months) after the 1-year echocardiography, the rate of the primary endpoint was significantly higher among patients with persistently low TAPSE than that among others (n = 31 (40%) vs. n = 39 (21%), respectively, log-rank p < 0.001). Cox multivariate analysis revealed that persistently low TAPSE was independently associated with adverse events (Hazard ratio, 1.975; 95% confidence interval 1.183-3.295; p = 0.009). Exactly 30% of hospitalized patients with HFrEF had low TAPSE both pre- and 1-year post-discharge. Persistently low TAPSE had independent predictive value of prognosis in these patients.
在左心室射血分数降低的心力衰竭（HF）患者（HFrEF）中，超声心动图显示三尖瓣环平面收缩期位移（TAPSE）较低与预后不良相关。HFrEF患者HF治疗后TAPSE变化的意义仍不明确。我们评估了日本住院HFrEF患者中与持续低TAPSE相关的因素及其预后影响。我们对2015年至2019年在东京女子医科大学住院的HF患者进行的前瞻性观察性HIJ-HF III研究中的260例HFrEF患者进行了前瞻性检查。持续低TAPSE定义为出院前和出院后1年的超声心动图检查中TAPSE均<17 mm。该研究的主要终点是全因死亡率或因HF再次住院。比较了有和没有持续低TAPSE的患者的预后和特征。利用患者特征和超声心动图数据，采用逻辑回归分析评估与持续低TAPSE相关的因素。我们使用Cox比例风险模型确定了持续低TAPSE对HFrEF患者的预后影响。260例患者中有78例（30%）持续TAPSE较低。他们的纽约心脏协会功能分级较高；基线TAPSE和左心室射血分数较低；使用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂的情况较少。与持续低TAPSE相关的显著因素包括出院后1年时较高的脑钠肽水平、较低的基线TAPSE和室间隔s'水平。在1年超声心动图检查后的32个月（范围12 - 69个月）随访期内，持续低TAPSE的患者的主要终点发生率显著高于其他患者（分别为n = 31例（40%）和n = 39例（21%），对数秩检验p < 0.001）。Cox多变量分析显示，持续低TAPSE与不良事件独立相关（风险比，1.975；95%置信区间1.183 - 3.295；p = 0.009）。确切地说，30%的住院HFrEF患者在出院前和出院后1年TAPSE均较低。持续低TAPSE对这些患者的预后具有独立预测价值。
