Fino Carlo, Bellavia Diego, D'Alonzo Michele, Merlo Maurizio, Bruno Vito D, Magne Julien, Caputo Massimo, Terzi Amedeo, Senni Michele, Bichi Samuele, Simon Caterina, Sciatti Edoardo, Marchetto Giovanni, Iacovoni Attilio, Pibarot Philippe
Cardiovascular and Transplant Department Ospedale Papa Giovanni XXIII Bergamo Italy.
Division of Cardiovascular Diseases Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT) Palermo Italy.
J Am Heart Assoc. 2025 Apr 15;14(8):e037198. doi: 10.1161/JAHA.124.037198. Epub 2025 Apr 11.
The exercise assessment of the right ventricular-pulmonary arterial (PA) coupling adds diagnostic and prognostic value in patients with heart failure. In patients with ischemic mitral regurgitation undergoing surgery, data on the exercise assessment of the right ventricular-PA coupling are not available. Resting and exercise echocardiographic predictors of functional outcome in patients with ischemic mitral regurgitation were tested.
Six-minute walking test and exercise echocarrdiogram performed at baseline, at 1 years, and at a median follow-up of 6 years (interquartile range, 3.70; range, 4.5-8) on 50 patients (67±8 years; ejection fraction: 35±5%) undergoing valve replacement or repair. Linear mixed models were used to evaluate the predictive value of preoperative echocardiographic parameters on the longitudinal distribution of the 6-minute walking test.
Preoperative exercise tricuspid annular plane systolic excursion (TAPSE)/PA systolic pressure strongly correlated with the long-term 6-minute walking test (r=0.81, <0.01). The receiver operating characteristic analysis found a preoperative exercise TAPSE/PA systolic pressure <0.34 predicted the lowest quartile of the 6-minute walking test in the long term (sensitivity: 79%; specificity: 100%) as well as a composite outcome of heart failure and death from any cause (positive predictive value: 91.3%, negative predictive value: 100%). On multivariable analysis, TAPSE and TAPSE/PA systolic pressure were significantly associated with a better long-term 6-minute walking test.
A preoperative exercise TAPSE/PA systolic pressure <0.34 predicts a poor functional performance and a higher likelihood of clinical adverse events. In patients with ischemic mitral regurgitation the exercise right ventricular -PA coupling could improve risk stratification. Larger studies are needed.
右心室-肺动脉(PA)耦合的运动评估可为心力衰竭患者增加诊断和预后价值。在接受手术的缺血性二尖瓣反流患者中,尚无关于右心室-PA耦合运动评估的数据。对缺血性二尖瓣反流患者功能结局的静息和运动超声心动图预测指标进行了测试。
对50例接受瓣膜置换或修复的患者(67±8岁;射血分数:35±5%)在基线、1年时以及中位随访6年(四分位间距,3.70;范围,4.5 - 8)时进行6分钟步行试验和运动超声心动图检查。采用线性混合模型评估术前超声心动图参数对6分钟步行试验纵向分布的预测价值。
术前运动时三尖瓣环平面收缩期位移(TAPSE)/PA收缩压与长期6分钟步行试验密切相关(r = 0.81,<0.01)。受试者工作特征分析发现,术前运动时TAPSE/PA收缩压<0.34可预测长期6分钟步行试验的最低四分位数(敏感性:79%;特异性:100%)以及心力衰竭和任何原因导致的死亡的复合结局(阳性预测值:91.3%,阴性预测值:100%)。多变量分析显示,TAPSE和TAPSE/PA收缩压与更好的长期6分钟步行试验显著相关。
术前运动时TAPSE/PA收缩压<0.34预示功能表现较差且临床不良事件发生的可能性较高。在缺血性二尖瓣反流患者中,运动时右心室-PA耦合可改善危险分层。需要开展更大规模的研究。