Malahfji Maan, Bhugra Priyanka, Nguyen Duc T, Crudo Valentina, Saeed Mujtaba, Reardon Michael, Nagueh Sherif F, Zoghbi William A, Graviss Edward A, Shah Dipan J
From the Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St, Smith Tower, Ste 1801, Houston, TX 77030 (M.M., P.B., V.C., M.S., M.R., S.F.N., W.A.Z., D.J.S.); and Department of Pathology and Genomic Medicine, Houston Methodist Hospital Research Institute, Houston, Tex (D.T.N., E.A.G.).
Radiol Cardiothorac Imaging. 2025 Feb;7(1):e230389. doi: 10.1148/ryct.230389.
Purpose To investigate the determinants and effect of right ventricular (RV) dysfunction in aortic regurgitation (AR) using cardiac MRI. Materials and Methods This study included patients with moderate or severe AR who were enrolled in the DEBAKEY-CMR registry between January 2009 and June 2020. Patients with previous valve intervention, cardiomyopathy deemed unrelated to AR, severe aortic stenosis, and other confounders were excluded. RV dysfunction (RV ejection fraction ≤ 40%) was measured at cardiac MRI. Outcomes were all-cause death, cardiovascular death, and perioperative mortality. Factors associated with RV dysfunction and its association with outcomes were assessed using univariable and multivariable Cox regression analyses. Results The study included 395 patients (median age, 62 years [IQR, 51-72 years]; 79% male). Fifty-eight (14.6%) patients had RV dysfunction. Patients with RV dysfunction had higher New York Heart Association class, greater biventricular remodeling, greater coexisting mitral and tricuspid regurgitation, and a higher prevalence of left ventricular dysfunction. In multivariable analysis, factors independently associated with RV dysfunction were coexisting mitral regurgitation (odds ratio per unit of mitral regurgitant fraction, 1.05; = .001) and reduced left ventricular ejection fraction (odds ratio, 1.14; < .001). RV dysfunction helped independently predict mortality (hazard ratio [HR], 2.35; 95% CI: 1.07, 5.19; = .03) and cardiovascular death (HR, 3.29; 95% CI: 1.18, 9.1; = .02), as well as a higher rate of 90-day perioperative mortality (four of 58 [6.9%]), compared with two of 337 (0.6%) in patients without RV dysfunction; = .005). Conclusion In patients with chronic AR, the strongest factors associated with RV dysfunction were coexisting mitral regurgitation and left ventricular dysfunction. Patients with RV dysfunction had a higher risk of death from any cause, cardiovascular death, and excess perioperative mortality. Cardiac, Cartilage Imaging, Cardiac MRI, Aortic Regurgitation, Right Ventricular Dysfunction Clinical trial registration no. NCT04281823 ©RSNA, 2025.
目的 利用心脏磁共振成像（MRI）研究主动脉瓣关闭不全（AR）患者右心室（RV）功能障碍的决定因素及其影响。材料与方法 本研究纳入2009年1月至2020年6月期间登记在DEBAKEY-CMR注册研究中的中重度AR患者。排除既往有瓣膜干预、与AR无关的心肌病、重度主动脉瓣狭窄及其他混杂因素的患者。通过心脏MRI测量RV功能障碍（RV射血分数≤40%）。观察指标为全因死亡、心血管死亡和围手术期死亡率。采用单变量和多变量Cox回归分析评估与RV功能障碍相关的因素及其与观察指标的关联。结果 本研究纳入395例患者（中位年龄62岁[四分位间距，51 - 72岁]；79%为男性）。58例（14.6%）患者存在RV功能障碍。存在RV功能障碍的患者纽约心脏协会心功能分级更高、双心室重构更明显、二尖瓣和三尖瓣反流并存情况更严重，且左心室功能障碍患病率更高。在多变量分析中，与RV功能障碍独立相关的因素为并存的二尖瓣反流（每单位二尖瓣反流分数的比值比，1.05；P = .001）和左心室射血分数降低（比值比，1.14；P < .001）。RV功能障碍有助于独立预测死亡率（风险比[HR]，2.35；95%可信区间：1.07，5.19；P = .03）和心血管死亡（HR，3.29；95%可信区间：1.18，9.1；P = .02），以及90天围手术期死亡率更高（58例中有4例[6.9%]），而无RV功能障碍的337例患者中有2例（0.6%）；P = .005）。结论 在慢性AR患者中，与RV功能障碍相关的最强因素是并存的二尖瓣反流和左心室功能障碍。存在RV功能障碍的患者全因死亡、心血管死亡及围手术期死亡风险更高。心脏、软骨成像、心脏MRI、主动脉瓣关闭不全、右心室功能障碍 临床试验注册号：NCT04281823 ©RSNA，2025
