Kitano Tetsuji, Nagata Yasufumi, Nabeshima Yosuke, Dohi Kaoru, Takeuchi Masaaki
Department of Clinical Training and Career Support Center, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
J Echocardiogr. 2025 Aug 19. doi: 10.1007/s12574-025-00704-z.
There are few studies reporting the prognostic value of three-dimensional echocardiography (3DE)-derived right ventricular ejection fraction (RVEF) in patients with ischemic cardiomyopathy (ICM) and dilated cardiomyopathy (DCM).
120 ICM and 107 DCM patients who underwent 3DE were retrospectively selected and analyzed using 3DE speckle tracking software. The primary endpoint was a composite of cardiac events, including cardiac death, heart failure hospitalization, myocardial infarction, or ventricular tachyarrhythmia.
During a median follow-up of 24.3 and 53.6 months, 45 patients in ICM and 39 patients in DCM, respectively, reached the primary endpoint. Univariate analysis showed that RVEF was statistically significantly associated with cardiac events in both groups [ICM, hazard ratio (HR): 0.92, 95% confidence interval (CI) 0.89-0.95; DCM, HR: 0.90, 95% CI 0.86-0.93, respectively]. In multivariable analysis, RVEF (HR: 0.89-0.92, p < 0.001) was also statistically significantly associated with cardiac events in both ICM and DCM, even after adjustment for clinical factors, left ventricular (LV) systolic and diastolic parameters, or RV systolic parameters. Kaplan-Meier curves, divided into four groups by RVEF ≥ 45% and < 45% and E/e' ≥ 14 and < 14, showed significant risk stratification for both ICM (p = 0.0068) and DCM (p < 0.0001). RVEF had incremental prognostic value over age, E/e', and conventional RV systolic parameters, in both ICM and DCM.
This study confirms the independent and incremental prognostic value of RVEF over conventional echocardiographic parameters in patients with ICM and DCM and allows detailed risk stratification of cardiac events by RVEF and E/e'.
关于三维超声心动图（3DE）得出的右心室射血分数（RVEF）对缺血性心肌病（ICM）和扩张型心肌病（DCM）患者的预后价值，相关研究较少。
回顾性选取120例接受3DE检查的ICM患者和107例DCM患者，使用3DE斑点追踪软件进行分析。主要终点是心脏事件的复合指标，包括心源性死亡、心力衰竭住院、心肌梗死或室性快速心律失常。
在ICM组和DCM组的中位随访时间分别为24.3个月和53.6个月期间，分别有45例ICM患者和39例DCM患者达到主要终点。单因素分析显示，两组中RVEF与心脏事件均存在显著统计学关联[ICM组，风险比（HR）：0.92，95%置信区间（CI）0.89 - 0.95；DCM组，HR：0.90，95%CI 0.86 - 0.93]。多变量分析中，即使在调整临床因素、左心室（LV）收缩和舒张参数或右心室收缩参数后，RVEF（HR：0.89 - 0.92，p < 0.001）在ICM组和DCM组中与心脏事件仍存在显著统计学关联。根据RVEF≥45%和<45%以及E/e'≥14和<14分为四组的Kaplan-Meier曲线显示，ICM组（p = 0.0068）和DCM组（p < 0.0001）均有显著的风险分层。在ICM组和DCM组中，RVEF较年龄、E/e'和传统右心室收缩参数具有额外的预后价值。
本研究证实了RVEF在ICM和DCM患者中相对于传统超声心动图参数具有独立且额外的预后价值，并可通过RVEF和E/e'对心脏事件进行详细的风险分层。
