Lu Henri, Inciardi Riccardo M, Abanda Martin, Shah Amil M, Cikes Maja, Claggett Brian L, Prasad Narayana, Lam Carolyn S P, Redfield Margaret, McMurray John J V, Pfeffer Marc A, Solomon Scott D, Hegde Sheila M, Skali Hicham
Division of Cardiovascular Medicine, Brigham and Women's Hospital Harvard Medical School Boston MA USA.
Division of Cardiology Lausanne University Hospital (CHUV), University of Lausanne (UNIL) Lausanne Switzerland.
J Am Heart Assoc. 2025 Jan 7;14(1):e037380. doi: 10.1161/JAHA.124.037380. Epub 2024 Dec 24.
This study aims to characterize right ventricular dysfunction (RVD) in heart failure (HF) with preserved ejection fraction and understand the cumulative prognostic value of abnormal RV echocardiographic parameters in HF with preserved ejection fraction.
Data from 809 patients in the PARAGON-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With Angiotensin-Receptor Blocker Global Outcomes in HF With Preserved Ejection Fraction) echocardiographic substudy (55% women, mean age 74±8 years) were analyzed. Correlates of RVD (defined as tricuspid annular plane systolic excursion <1.7 cm, fractional area change <35% or absolute RV free wall longitudinal strain <20%) were identified using multivariable logistic regression models. We further assessed the prognostic value of the number of abnormal RV parameters (0, 1, ≥2) on total HF hospitalizations (HFH) and cardiovascular death, total HFH, first HFH or cardiovascular death, all-cause death, and cardiovascular death. RVD was identified in 461 (57%) patients. Correlates of RVD included older age, higher heart rate, atrial fibrillation/flutter, greater left ventricle wall thickness, higher N-terminal pro-B-type natriuretic peptide levels, lower systolic blood pressure, and lower left ventricle absolute global longitudinal strain. These results were consistent across sexes, except atrial fibrillation/flutter and LV wall thickness, which were associated with a higher risk of RVD in men but not in women. Participants with ≥2 abnormal RV parameters had a significantly higher adjusted risk of total HFH and cardiovascular death (rate ratio, 2.13 [95% CI, 1.13-4.01]), first HFH or cardiovascular death, all-cause death, and cardiovascular death. Conversely, an isolated abnormal RV parameter was not associated with a worse outcome.
RV measures may underestimate the burden of RVD in HF with preserved ejection fraction when considered in isolation. Clinicians should consider multiple dimensions to comprehensively assess RV function in patients with HF with preserved ejection fraction.
本研究旨在描述射血分数保留的心力衰竭（HFpEF）患者的右心室功能障碍（RVD）特征，并了解右心室超声心动图参数异常在HFpEF中的累积预后价值。
分析了PARAGON-HF（射血分数保留的心力衰竭中血管紧张素受体脑啡肽酶抑制剂与血管紧张素受体阻滞剂全球预后的前瞻性比较）超声心动图亚研究中809例患者的数据（55%为女性，平均年龄74±8岁）。使用多变量逻辑回归模型确定RVD的相关因素（定义为三尖瓣环平面收缩期位移<1.7 cm、面积变化分数<35%或右心室游离壁绝对纵向应变<20%）。我们进一步评估了异常右心室参数数量（0、1、≥2）对总心力衰竭住院（HFH）和心血管死亡、总HFH、首次HFH或心血管死亡、全因死亡和心血管死亡的预后价值。461例（57%）患者被确定存在RVD。RVD的相关因素包括年龄较大、心率较高、心房颤动/扑动、左心室壁厚度增加、N末端B型利钠肽前体水平较高、收缩压较低以及左心室绝对整体纵向应变较低。除心房颤动/扑动和左心室壁厚度外，这些结果在两性中均一致，心房颤动/扑动和左心室壁厚度与男性RVD风险较高相关，但与女性无关。具有≥2个异常右心室参数的参与者总HFH和心血管死亡的调整风险显著更高（率比，2.13 [95% CI，1.13 - 4.01]），首次HFH或心血管死亡、全因死亡和心血管死亡也是如此。相反，孤立的异常右心室参数与更差的结局无关。
单独考虑时，右心室测量可能低估射血分数保留的心力衰竭患者中RVD的负担。临床医生应从多个维度综合评估射血分数保留的心力衰竭患者的右心室功能。
