Right ventricular dysfunction as an independent predictor of short- and long-term mortality in patients with heart failure
Right ventricular dysfunction as an independent predictor of short- and long-term mortality in patients with heart failure
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DOI：
10.1016/j.ejheart.2007.03.001
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发表时间：
2007-06-01
影响因子：
18.2
通讯作者：
Hassager, Christian
中科院分区：
文献类型：
--
作者：
Kjaergaard, Jesper;Akkan, Dilek;Hassager, Christian
背景资料：在严重收缩性心力衰竭患者中，右心室（RV）功能障碍对心力衰竭（HE）的预后具有重要意义。三尖瓣环平面收缩期偏移（TAPSE）是一种简单的超声心动图测量RV射血分数的方法，但可能受到共存的慢性阻塞性肺疾病（COPD）的影响。目的：在一系列因新发或恶化HF入院的患者中，检查TAPSE的预后信息，调整了共存的心血管和COPD的潜在混杂效应。方法和结果：通过经胸超声心动图（包括TAPSE测量）筛选参与大型临床试验的817例患者，中位随访时间为4.1年（最长5.5年）。TAPSE降低以及COPD的存在与不良的短期和长期生存独立相关，风险比为0.74（p=0.004）对于TAPSE的每次加倍;和2.4（p < 0.0001）。结论：TAPSE评估的RV收缩功能下降与因HF入院患者的死亡率增加相关，并且与包括左心室功能在内的HF中的其他危险因素无关。COPD的共存也与独立于RV收缩功能的不良预后相关。(C)2007年欧洲心脏病学会。Elsevier B. V.出版，保留所有权利。
Background: The prognostic importance of right ventricular (RV) dysfunction in heart failure (HE) has been suggested in patients with severe systolic heart failure. Tricuspid annular plane systolic excursion (TAPSE) is a simple echocardiographic measure of RV ejection fraction, but may be affected by co-existing chronic obstructive pulmonary disease (COPD).Aims: To examine the prognostic information from TAPSE adjusted for the potential confounding effects of co-existing cardiovascular and COPD in a large series of patients admitted for new onset or worsening HF.Methods and results: Eight hundred and seventeen patients screened for participation in a large clinical trial by trans-thoracic echocardiography, including measurement of TAPSE, were followed for a median of 4.1 years (maximum 5.5 years). Decreased TAPSE as well as presence of COPD were independently associated with adverse short- and long-term survival, hazard ratio was 0.74 (p=0.004) for every doubling of TAPSE; and 2.4 (p < 0.0001) for the presence of COPD.Conclusion: Decreased RV systolic function as estimated by TAPSE is associated with increased mortality in patients admitted for HF, and is independent of other risk factors in HF including left ventricular function. The co-existence of COPD is also associated with an adverse prognosis independent of the RV systolic function. (C) 2007 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.