利用右心室功能作为围产期心肌病恢复预测指标的研究进展：一项单中心前瞻性队列研究
The Advances in Utilizing Right Ventricular Function as a Predictor of Peripartum Cardiomyopathy Recovery: A Single Centre Prospective Cohort Study.
作者信息
Akbar Mohammad Rizki, Sakasasmita Sylvie, Achmad Chaerul, Dewi Triwedya Indra, Hasan Melawati, Prameswari Hawani Sasmaya
机构信息
Department of Cardiology and Vascular Medicine/ Dr. Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia.
出版信息
Int J Gen Med. 2025 Jan 20;18:299-308. doi: 10.2147/IJGM.S477008. eCollection 2025.
INTRODUCTION
Peripartum cardiomyopathy (PPCM) is a pregnancy related cardiomyopathy with a high potential for recovery. One of the contemporary predictors studied in cardiomyopathy is right ventricular (RV) function during initial presentation.
PURPOSE
This study aimed to determine the role of RV systolic function based on the various RV function parameters by two-dimensional transthoracic echocardiography (2DE) to predict PPCM recovery within 6 months of follow-up and identify the most accurate parameter among them.
PATIENTS AND METHODS
This was a prospective cohort study that include all patients registered in the "Long Term Registry on Patients with Peripartum Cardiomyopathy" at Dr. Hasan Sadikin General Hospital Indonesia during period of September 2014 until December 2022. Right ventricular systolic dysfunction was defined as abnormal value in one or more parameter(s), including tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), S', right ventricular free wall longitudinal strain (RVFWLS) and right ventricular global longitudinal strain (RVGLS). Left ventricular ejection fraction was measured on initial examination and after 6-month follow up to define recovery.
RESULTS
A total of 95 patients were included in this study. There were 33 patients (34.7%) with reduced initial RV systolic function. Sixty-four patients (67.4%) recovered within 6 months follow up. The recovery rate of patients with initial RV systolic dysfunction is lower than patients with normal RV systolic function (51.5% vs 75.8%, p = 0.016). This study showed that initial RV systolic dysfunction can predict poor LV function recovery in PPCM patients (OR 0.340; 95% CI:0.120-0.959; p = 0.041). Among all RV function parameters, only FAC (OR 1.076; 95% CI:1.003-1.154; p = 0.040)) and RVGLS (OR 0.768; 95% CI: 0.595-0.991; p = 0.042) emerged as independent predictors of PPCM recovery.
CONCLUSION
Right ventricular function in terms of FAC and/or RVGLS at initial diagnosis can be used as a predictor for PPCM recovery at 6 months follow-up.
引言
围产期心肌病（PPCM）是一种与妊娠相关的心肌病，具有较高的恢复潜力。心肌病研究中当代的预测指标之一是初始就诊时的右心室（RV）功能。
目的
本研究旨在通过二维经胸超声心动图（2DE）基于各种右心室功能参数确定右心室收缩功能在预测随访6个月内PPCM恢复情况中的作用，并找出其中最准确的参数。
患者与方法
这是一项前瞻性队列研究，纳入了2014年9月至2022年12月期间在印度尼西亚哈桑·萨迪金综合医院“围产期心肌病患者长期登记处”登记的所有患者。右心室收缩功能障碍定义为一个或多个参数值异常，包括三尖瓣环平面收缩期位移（TAPSE）、面积变化分数（FAC）、S'、右心室游离壁纵向应变（RVFWLS）和右心室整体纵向应变（RVGLS）。在初始检查时和随访6个月后测量左心室射血分数以定义恢复情况。
结果
本研究共纳入95例患者。33例患者（34.7%）初始右心室收缩功能降低。64例患者（67.4%）在随访6个月内恢复。初始右心室收缩功能障碍患者的恢复率低于右心室收缩功能正常的患者（51.5%对75.8%，p = 0.016）。本研究表明，初始右心室收缩功能障碍可预测PPCM患者左心室功能恢复不良（OR 0.340；95% CI：0.120 - 0.959；p = 0.041）。在所有右心室功能参数中，只有FAC（OR 1.076；95% CI：1.003 - 1.154；p = 0.040）和RVGLS（OR 0.768；95% CI：0.595 - 0.991；p = 0.042）成为PPCM恢复的独立预测指标。
结论
初始诊断时基于FAC和/或RVGLS的右心室功能可作为随访6个月时PPCM恢复情况的预测指标。
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