[右心室与肺动脉系统相互作用对慢性心力衰竭急性失代偿不良结局发生发展的影响]

[The influence of the interaction of right ventricle and pulmonary artery system on the development of adverse outcomes in acute decompensation of chronic heart failure].

作者信息

Islamova M R, Safarova A F, Kobalava Z D

机构信息

University Medical Center named after Vladimir Vinogradov, branch of Peoples' Friendship University of Russia named after Patrice Lumumba.

Peoples' Friendship University of Russia named after Patrice Lumumba.

出版信息

Ter Arkh. 2025 Apr 15;97(3):234-241. doi: 10.26442/00403660.2025.03.203135.

DOI:10.26442/00403660.2025.03.203135

PMID:40327617

Abstract

AIM

To determine the frequency and prognostic significance of right ventricular-pulmonary artery (RV-PA) uncoupling, in the development of cardiovascular complications in patients with acute decompensation of chronic heart failure (ADCHF).

MATERIALS AND METHODS

The prospective single-center observational study included 171 patients with ADCHF. Tricuspid Annular Plane Systolic Excursion (TAPSE)/PA systolic pressure <0.36 mm/mmHg by 2D echocardiography was used as the indicator of the right ventricular-pulmonary artery RV-PA uncoupling.

RESULTS

The incidence of RV-PA uncoupling in the general population of patients with ADCHF was 67.2% (=129). Patients with RV-PA uncoupling had a more severe clinical status. RV-PA uncoupling was associated with male sex (odds ratio, OR 2.6, 95% CI 1.35-5.04; =0.004), myocardial infarction (OR 2.06, 95% CI 1.04-4.09; =0.037), and a history of cerebrovascular accident (OR 10.89, 95% CI 1.42-83.55; =0.005). Echocardiography showed more pronounced deviations in the structural and functional parameters of the right and left heart compartments and a higher PA systolic pressure. In ischemic heart disease, the risk of RV-PA uncoupling increased 2.85 times (95% CI 0.99-8.23; =0.053), and in diabetes mellitus, it increased 4.31 times (95% CI 1.19-15.56; =0.026). With an increase in the diameter of the inferior vena cava per unit, the risk of RV-PA uncoupling increased 9.49 times (95% CI 2.17-41.40; =0.003), and with an increase in the transverse size of the right atrium, it increased 2.83 times (95% CI 1.28-6.26; =0.010). In patients with RV-PA uncoupling, higher liver density was identified using transient elastography and reduced active and reactive resistance using bioimpedance vector analysis, regardless of right ventricular dysfunction. The effect of the RV-PA uncoupling on the overall hospitalization rate and related to ADCHF was shown.

CONCLUSION

The high frequency, clinical association, and prognostic significance of RV-PA uncoupling support RV-PA assessment in patients with ADCHF.

摘要

目的

确定右心室-肺动脉（RV-PA）解耦在慢性心力衰竭急性失代偿（ADCHF）患者心血管并发症发生中的频率及预后意义。

材料与方法

这项前瞻性单中心观察性研究纳入了171例ADCHF患者。二维超声心动图显示三尖瓣环平面收缩期位移（TAPSE）/肺动脉收缩压<0.36 mm/mmHg作为右心室-肺动脉RV-PA解耦的指标。

结果

ADCHF患者总体人群中RV-PA解耦的发生率为67.2%（=129）。RV-PA解耦的患者临床状态更严重。RV-PA解耦与男性（优势比，OR 2.6，95%可信区间1.35 - 5.04；=0.004）、心肌梗死（OR 2.06，95%可信区间1.04 - 4.09；=0.037）和脑血管意外病史（OR 10.89，95%可信区间1.42 - 83.55；=0.005）相关。超声心动图显示左右心腔结构和功能参数有更明显的偏差以及更高的肺动脉收缩压。在缺血性心脏病中，RV-PA解耦的风险增加2.85倍（95%可信区间0.99 - 8.23；=0.053），在糖尿病中增加4.31倍（95%可信区间1.19 - 15.56；=0.026）。下腔静脉直径每增加一个单位，RV-PA解耦的风险增加9.49倍（95%可信区间2.17 - 41.40；=0.003），右心房横径增加时，风险增加2.83倍（95%可信区间1.28 - 6.26；=0.010）。在RV-PA解耦的患者中，无论右心室功能障碍如何，使用瞬时弹性成像可发现肝脏密度更高，使用生物电阻抗矢量分析可发现主动和反应性阻力降低。显示了RV-PA解耦对总体住院率及与ADCHF相关情况的影响。