心血管危险因素患者右心及肺循环的运动负荷多普勒超声心动图：来自右心国际网络（RIGHT-NET）的观察结果
Exercise Doppler Echocardiography of the Right Heart and Pulmonary Circulation in Patients With Cardiovascular Risk Factors: Observations From the RIGHT Heart International NETwork (RIGHT-NET).
作者信息
De Luca Mariarosaria, Ferrara Francesco, Gargani Luna, Argiento Paola, Bandera Francesco, Carbone Andreina, Castaldo Rossana, D'Agostino Anna, D'Alto Michele, D'Andrea Antonello, D'Assante Roberta, Franzese Monica, Giardino Federica, Grünig Ekkehard, Kasprzak Jarosław D, Limongelli Giuseppe, Passaro Emanuela, Pugliese Nicola R, Rega Salvatore, Schiavo Alessandra, Vriz Olga, Wierzbowska-Drabik Karina, Cittadini Antonio, Naeije Robert, Bossone Eduardo, Marra Alberto Maria
机构信息
Department of Translational Medical Sciences, University of Naples "Federico II," Naples, Italy.
Cardio-Thoracic-Vascular Department, University Hospital "San Giovanni Di Dio E Ruggi D'Aragona," Salerno, Italy.
出版信息
Chest. 2025 Jun 19. doi: 10.1016/j.chest.2025.06.020.
BACKGROUND
The precise impact of cardiovascular risk factors (CVRFs) on the right ventricle-pulmonary circulation unit remains unclear.
RESEARCH QUESTION
Are there any differences regarding resting and exercise right ventricular function in patients with CVRFs but without overt cardiovascular disease when compared with healthy control patients?
STUDY DESIGN AND METHODS
We extracted from the Right Heart International Network international registry the data of 362 patients with at least 1 CVRF but no overt cardiovascular disease, and 375 healthy control patients. All patients and control patients had undergone resting and exercise echocardiographic evaluations on a semirecumbent cycle ergometer. Right ventricular-pulmonary arterial coupling was assessed using the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary arterial systolic pressure (sPAP) and pulmonary vascular function through the slope of mean pulmonary arterial pressure (mPAP) to cardiac output (CO) relationship, or dynamic total pulmonary vascular resistance. All-cause mortality and hospitalization events at follow-up were analyzed.
RESULTS
Patients with CVRFs had lower TAPSE/sPAP (P < .001) and a steeper mPAP/CO slope (P < .001) than control patients. A substantial proportion of patients with ≥ 2 CVRFs (38.2%) had mPAP/CO slopes ≥ 3 mm Hg.min/L. Patients with CVRFs also had worse exercise capacity with chronotropic incompetence. The presence of ≥ 2 CVRFs was associated with an additional negative impact on right ventricular systolic function as assessed by TAPSE. The presence of CVRFs affected outcome, with 1 event in healthy control patients compared with 12 events in patients with CVRFs (P < .001). However, no independent effect of TAPSE/sPAP or mPAP/CO was observed, likely due to the limited number of events.
INTERPRETATION
Patients with CVRFs exhibit echocardiographic evidence of right ventricular-pulmonary arterial uncoupling at rest and during exercise, along with elevated dynamic pulmonary vascular resistance, all of which are relevant to exercise capacity.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov; No.: NCT03041337; URL: www.
CLINICALTRIALS
gov.
背景
心血管危险因素（CVRFs）对右心室-肺循环单元的确切影响尚不清楚。
研究问题
与健康对照患者相比，患有心血管危险因素但无明显心血管疾病的患者在静息和运动时的右心室功能是否存在差异？
研究设计与方法
我们从右心国际网络国际注册中心提取了362例至少有1种心血管危险因素但无明显心血管疾病的患者以及375例健康对照患者的数据。所有患者和对照患者均在半卧位蹬车测力计上接受了静息和运动超声心动图评估。使用三尖瓣环平面收缩期位移（TAPSE）与肺动脉收缩压（sPAP）的比值评估右心室-肺动脉耦合，并通过平均肺动脉压（mPAP）与心输出量（CO）关系的斜率或动态总肺血管阻力评估肺血管功能。分析随访期间的全因死亡率和住院事件。
结果
与对照患者相比，患有心血管危险因素的患者TAPSE/sPAP较低（P <.001），mPAP/CO斜率较陡（P <.001）。相当一部分有≥2种心血管危险因素的患者（38.2%）mPAP/CO斜率≥3 mmHg·min/L。患有心血管危险因素的患者运动能力也较差，存在变时性功能不全。通过TAPSE评估，≥2种心血管危险因素的存在对右心室收缩功能有额外的负面影响。心血管危险因素的存在影响预后，健康对照患者发生1起事件，而患有心血管危险因素的患者发生12起事件（P <.001）。然而，未观察到TAPSE/sPAP或mPAP/CO的独立影响，可能是由于事件数量有限。
解读
患有心血管危险因素的患者在静息和运动时表现出右心室-肺动脉解耦的超声心动图证据，同时动态肺血管阻力升高，所有这些都与运动能力相关。
临床试验注册
ClinicalTrials.gov；编号：NCT03041337；网址：www. ClinicalTrials.gov 。
Zotero 插件