收缩末期右心房与右心室大小之比对诊断继发性三尖瓣反流的效用。
Utility of the Ratio Between the Size of the Right Atrium and the Right Ventricle at End-Systole to Diagnose Atrial Secondary Tricuspid Regurgitation.
作者信息
Clement Alexandra, Muraru Denisa, Fisicaro Samantha, Penso Marco, Tomaselli Michele, Radu Noela, Delcea Caterina, Buta Alexandra S, Rella Valeria, Sascau Radu, Badano Luigi P
机构信息
Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Internal Medicine Department, "Grigore T. Popa," University of Medicine and Pharmacy, Iasi, Romania.
Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy.
出版信息
J Am Soc Echocardiogr. 2025 Mar;38(3):212-223. doi: 10.1016/j.echo.2024.11.012. Epub 2024 Dec 11.
BACKGROUND
In the multiparametric framework for diagnosing atrial secondary tricuspid regurgitation (A-STR), an end-systolic (ES) right atrial (RA)-to-right ventricular (RV) volume or area ratio ≥1.5 supports the diagnosis of A-STR over the ventricular secondary tricuspid regurgitation phenotype (V-STR). However, this threshold value has never been tested.
METHODS
A single-center study was conducted, prospectively enrolling consecutive patients with secondary tricuspid regurgitation who underwent two- and three-dimensional echocardiography.
RESULTS
A total of 350 patients were enrolled (mean age, 75 ± 13 years; 65% women). Although patients with A-STR and V-STR presented similar degrees of secondary tricuspid regurgitation and comparable RA size, the ES RA/RV volume ratio was significantly larger in A-STR than in V-STR (1.75 [interquartile range, 1.35-2.45] vs 1.18 [interquartile range, 0.81-1.66], respectively; P < .001). On receiver operating characteristic analysis, the ES RA/RV volume ratio showed a significantly higher predictive power for A-STR (area under the curve [AUC], 0.73; 95% CI, 0.68-0.78) compared with RA maximum volume (AUC, 0.6; 95% CI, 0.54-0.66; P = .01), RA minimum volume (AUC, 0.59; 95% CI, 0.53-0.65; P = .007), and ratio of RA minimum volume to RV end-diastolic volume (AUC, 0.57; 95% CI, 0.51-0.63; P < .001). However, the predictive power of the ES RA/RV volume ratio (AUC, 0.73; 95% CI, 0.68-0.78) and the ES RA/RV area ratio (AUC, 0.76; 95% CI, 0.71-0.81) for the diagnosis of A-STR was similar (P = .58). The threshold value for ES RA/RV volume ratio that best distinguished between A-STR and V-STR was 1.40 (AUC, 0.68; 95% CI, 0.63-0.73), whereas for ES RA/RV area ratio, it was 1.6 (AUC, 0.64; 95% CI, 0.59-0.69). A multivariable model that included either ES RA/RV volume ratio or ES RA/RV area ratio, along with LV ejection fraction, RV ejection fraction, RV ES volume, and pulmonary artery systolic pressure, resulted in an AUC of 0.97 for differentiating between A-STR and V-STR.
CONCLUSIONS
ES RA/RV volume ratio ≥ 1.4 and ES RA/RV area ratio ≥ 1.6 support the diagnosis of A-STR over V-STR.
背景
在诊断心房性继发性三尖瓣反流（A-STR）的多参数框架中，收缩末期（ES）右心房（RA）与右心室（RV）的容积或面积比≥1.5支持A-STR的诊断，而非心室性继发性三尖瓣反流表型（V-STR）。然而，这一阈值从未经过验证。
方法
进行了一项单中心研究，前瞻性纳入连续的继发性三尖瓣反流患者，这些患者均接受了二维和三维超声心动图检查。
结果
共纳入350例患者（平均年龄75±13岁；65%为女性）。尽管A-STR和V-STR患者的继发性三尖瓣反流程度相似，RA大小相当，但A-STR患者的ES RA/RV容积比显著大于V-STR患者（分别为1.75[四分位间距，1.35 - 2.45]和1.18[四分位间距，0.81 - 1.66]；P <.001）。在接受者操作特征分析中，ES RA/RV容积比对A-STR的预测能力显著高于RA最大容积（曲线下面积[AUC]，0.6；95%可信区间，0.54 - 0.66；P =.01）、RA最小容积（AUC，0.59；95%可信区间，0.53 - 0.65；P =.007）以及RA最小容积与RV舒张末期容积之比（AUC，0.57；95%可信区间，0.51 - 0.63；P <.001）。然而，ES RA/RV容积比（AUC，0.73；95%可信区间，0.68 - 0.78）和ES RA/RV面积比（AUC，0.76；95%可信区间，0.71 - 0.81）对A-STR诊断的预测能力相似（P =.58）。最能区分A-STR和V-STR的ES RA/RV容积比阈值为1.40（AUC，0.68；95%可信区间，0.63 - 0.73），而ES RA/RV面积比的阈值为1.6（AUC，0.64；95%可信区间，0.59 - 0.69）。一个包含ES RA/RV容积比或ES RA/RV面积比，以及左心室射血分数、右心室射血分数、RV ES容积和肺动脉收缩压的多变量模型，区分A-STR和V-STR的AUC为0.97。
结论
ES RA/RV容积比≥1.4且ES RA/RV面积比≥1.6支持A-STR优于V-STR的诊断。
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