Scaravilli Vittorio, Scansani Silvia, Meani Paolo, Turconi Gloria, Guzzardella Amedeo, Bosone Marco, Bonetti Claudia, Vicenzi Marco, Morlacchi Letizia Corinna, Rossetti Valeria, Rosso Lorenzo, Blasi Francesco, Nosotti Mario, Grasselli Giacomo
Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan (MI), Italy.
Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan (MI), Italy.
PLoS One. 2024 Dec 20;19(12):e0314235. doi: 10.1371/journal.pone.0314235. eCollection 2024.
Lung transplant (LUTX) candidates have subclinical right ventricular (RV) dysfunction, which has not yet been assessed by speckle-tracking echocardiography (STE)-derived RV free-wall longitudinal strain (RVFWLS). To evaluate the prevalence of RV dysfunction by RVFWLS and its relationship with conventional RV echocardiographic indexes in LUTX candidates.
In a single-center prospective observational cohort study, from January 2021 to March 2023 consecutive LUTX candidates underwent cardiac catheterization, radionuclide ventriculography, standard and STE. The diagnostic accuracy of RV ejection fraction by ventriculography (RVEF), tricuspid annular plane excursion (TAPSE), fractional area change (FAC), tricuspid peak annulus systolic velocity (S') versus RVFWS were computed.
Thirty-four patients (female, 41%) with a mean age of 48 [36-59] years old enlisted for pulmonary fibrosis (35%) and cystic fibrosis (30%) were included. At cardiac catheterization, only 7 (23%) had pulmonary hypertension. Around 15-25% presented right heart enlargement. Tricuspid regurgitation was present in 20 (60%) of the patients. Median RVFWLS was -20.1% [-22.5%--17%], being impaired (> -20%) in 16 (47%) of the patients. RVFWLS identified the highest percentage (47%) of RV dysfunction, compared to TAPSE (32%), S' (27%), FAC (26%), and ventriculography (15%), which had very low sensitivity for detecting RV dysfunction compared to RVFWLS.
In patients enlisted for LUTX, RV dysfunction assessed by STE-derived RVFWLS is highly prevalent. STE can detect RV dysfunction better than standard two-dimensional echocardiography and ventriculography. Further studies are urgently needed to define the clinical implications and the prognostic value of RV dysfunction measured with RVFWLS.
肺移植（LUTX）候选者存在亚临床右心室（RV）功能障碍，而斑点追踪超声心动图（STE）衍生的右心室游离壁纵向应变（RVFWLS）尚未对其进行评估。目的是通过RVFWLS评估LUTX候选者右心室功能障碍的患病率及其与传统右心室超声心动图指标的关系。
在一项单中心前瞻性观察队列研究中，2021年1月至2023年3月，连续的LUTX候选者接受了心导管检查、放射性核素心室造影、标准超声心动图和STE检查。计算了心室造影右心室射血分数（RVEF）、三尖瓣环平面位移（TAPSE）、面积变化分数（FAC）、三尖瓣环收缩期峰值速度（S'）与RVFWS的诊断准确性。
纳入了34例患者（女性占41%），平均年龄48[36 - 59]岁，病因包括肺纤维化（35%）和囊性纤维化（30%）。在心导管检查时，只有7例（23%）患有肺动脉高压。约15 - 25%出现右心扩大。20例（60%）患者存在三尖瓣反流。RVFWLS中位数为-20.1%[-22.5%--17%]，16例（47%）患者存在功能受损（> -20%）。与TAPSE（32%）、S'（27%）、FAC（26%）和心室造影（15%）相比，RVFWLS识别出的右心室功能障碍百分比最高（47%），与RVFWLS相比，这些指标检测右心室功能障碍的敏感性非常低。
在LUTX候选患者中，通过STE衍生的RVFWLS评估的右心室功能障碍非常普遍。STE检测右心室功能障碍的能力优于标准二维超声心动图和心室造影。迫切需要进一步研究来确定RVFWLS测量的右心室功能障碍的临床意义和预后价值。
