Goto Kohsaku, Soma Katsura, Tokiwa Hiroyuki, Umei Masahiko, Saito Akihito, Fujiu Katsuhito, Inuzuka Ryo, Hirata Yasutaka, Takeda Norihiko, Yao Atsushi
Department of Cardiovascular Medicine, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.
Department of Computational Diagnostic Radiology and Preventive Medicine, the University of Tokyo Hospital, Tokyo, Japan.
CJC Pediatr Congenit Heart Dis. 2024 Jul 23;3(5):191-199. doi: 10.1016/j.cjcpc.2024.07.002. eCollection 2024 Oct.
Progressive systemic right ventricle (sRV) dysfunction is a significant challenge in adult congenital heart disease. Current guidelines do not specify effective heart failure medications for patients with sRV; however, previous studies have relied on semiquantitative assessments. The advancement of cardiac magnetic resonance (CMR) imaging as the gold-standard modality offers quantitatively accurate assessments even for complex cardiac anomalies. Therefore, we aimed to investigate prognostic factors associated with sRV dysfunction in patients on angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACE-I/ARB), using CMR-derived quantitative values.
We conducted a retrospective cohort study of 17 adult patients with sRV treated with ACE-I/ARB and performed logistic regression analysis, with the primary outcome defined as sRV ejection fraction (sRVEF) deterioration.
Over an average follow-up period of 68.7 months, sRVEF deterioration occurred in 3 patients (17%). Logistic regression analysis identified tricuspid regurgitation (TR) as a potential independent prognostic factor for the primary outcome (odds ratio = 1.11; 95% confidence interval, 1.00-1.31). Furthermore, patients with mild TR (TR fraction ≤15%; N = 12) experienced improvements in sRVEF between the initial and last CMR assessments (from 49.1% ± 8.4% to 56.7% ± 8.0%, = 0.0029), with increased stroke volume from 68.2 ± 18.6 to 79.5 ± 17.2 mL ( = 0.0029). In contrast, these changes were not observed in patients with moderate or severe TR (TR fraction >16%) (N = 5).
Our CMR-based evaluation highlights the potential utility of TR stratification in predicting the changes in sRVEF among patients with sRV on ACE-I/ARB. Future randomized controlled trials that consider TR severity are required to elucidate the significance of ACE-I/ARB therapy.
进行性系统性右心室（sRV）功能障碍是成人先天性心脏病面临的一项重大挑战。当前指南未明确针对sRV患者的有效心力衰竭药物；然而，既往研究依赖半定量评估。心脏磁共振（CMR）成像作为金标准检查手段的发展，即使对于复杂心脏畸形也能提供定量准确的评估。因此，我们旨在利用CMR得出的定量值，研究接受血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（ACE-I/ARB）治疗的患者中与sRV功能障碍相关的预后因素。
我们对17例接受ACE-I/ARB治疗的成年sRV患者进行了一项回顾性队列研究，并进行了逻辑回归分析，主要结局定义为sRV射血分数（sRVEF）恶化。
在平均68.7个月的随访期内，3例患者（占17%）出现sRVEF恶化。逻辑回归分析确定三尖瓣反流（TR）是主要结局的潜在独立预后因素（比值比=1.11；95%置信区间，1.00-1.31）。此外，轻度TR（TR分数≤15%；n=12）患者在首次和末次CMR评估之间sRVEF有所改善（从49.1%±8.4%提高到56.7%±8.0%，P=0.0029），每搏输出量从68.2±18.6增加到79.5±17.2ml（P=0.0029）。相比之下，中度或重度TR（TR分数>16%）患者（n=5）未观察到这些变化。
我们基于CMR的评估突出了TR分层在预测接受ACE-I/ARB治疗的sRV患者sRVEF变化方面的潜在效用。未来需要开展考虑TR严重程度的随机对照试验，以阐明ACE-I/ARB治疗的意义。
