Outcome Prediction by Quantitative Right Ventricular Function Assessment in 575 Subjects Evaluated for Pulmonary Hypertension
Outcome Prediction by Quantitative Right Ventricular Function Assessment in 575 Subjects Evaluated for Pulmonary Hypertension
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DOI：
10.1161/circimaging.113.000640
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发表时间：
2013-09-01
影响因子：
7.5
通讯作者：
Kane, Garvan C.
中科院分区：
文献类型：
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作者：
Fine, Nowell M.;Chen, Libo;Kane, Garvan C.
背景虽然右心室（RV）功能障碍是肺动脉高压（PH）患者预后的一个主要决定因素，但RV功能的最佳测量方法尚不明确。我们假设斑点追踪超声心动图测量的RV应变可预测肺动脉高压患者在广泛肺动脉压范围内的预后。方法和结果对575例患者进行前瞻性RV纵向收缩期峰值应变测量平均年龄5618岁; 63%的女性）因已知或疑似PH而接受超声心动图检查。（四分位距，7.6-20.0）个月。有406例PH患者（71%）（第1组74%，第3组14%，第4组12%）和169例无PH证据的患者（29%）。在PH患者中，46%为世界卫生组织功能分级III-IV级。所有患者的平均RV应变为-21.2 +/- 6.7%。RV应变随着功能分级变差、6分钟步行距离变短、N末端B型利钠肽前体水平升高和右心衰竭的出现而下降。RV应变可预测肺动脉压和PH组的预后。根据RV应变四分位数，18个月生存率分别为92%、88%、85%和71%（P
Background Although right ventricular (RV) dysfunction is a major determinant of outcome in patients with pulmonary hypertension (PH), the optimal measure of RV function is poorly defined. We hypothesized that RV strain measured by speckle-tracking echocardiography predicts outcome in PH over a broad range of pulmonary pressures.Methods and Results Prospective peak RV longitudinal systolic strain measurement was performed on 575 patients (mean age, 5618 years; 63% women) referred for echocardiography for known or suspected PH. Survival status was assessed over a median of 16.5 (interquartile range, 7.6-20.0) months. There were 406 patients with PH (71%) (74% group 1, 14% group 3, and 12% group 4) and 169 patients without evidence of PH (29%). Among patients with PH, 46% were World Health Organization functional class III-IV. The mean RV strain was -21.2 +/- 6.7% for all patients. RV strain declined with worse functional class, shorter 6-minute walk distances, higher N-terminal pro-B-type natriuretic peptide levels, and the presence of right heart failure. RV strain predicted outcome across pulmonary pressures and groups of PH. Eighteen-month survival was 92%, 88%, 85%, and 71% according to RV strain quartile (P