Superior Prognostic Value of Right Ventricular Free Wall Compared to Global Longitudinal Strain in Patients With Heart Failure
Superior Prognostic Value of Right Ventricular Free Wall Compared to Global Longitudinal Strain in Patients With Heart Failure
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DOI：
10.1016/j.echo.2019.02.011
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发表时间：
2019-07-01
影响因子：
6.5
通讯作者：
Ambrosio, Giuseppe
中科院分区：
文献类型：
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作者：
Carluccio, Erberto;Biagioli, Paolo;Ambrosio, Giuseppe
背景：整体右心室 (RV) 纵向应变 (RVGLS) 和游离壁 RV 纵向应变 (RVFWS) 均被主张作为评估 RV 功能和预测射血分数降低 (HFrEF) 心力衰竭患者预后的敏感工具。然而，由于室间隔也是左心室 (LV) 的组成部分，RVGLS 可能会受到 LV 功能障碍的影响。因此，我们比较了 HFrEF 患者中任一 RV 应变参数的预后表现，同时考虑了 LV 收缩功能障碍的程度。 方法：在 288 名前瞻性入组的稳定 HFrEF 门诊患者中，通过斑点追踪评估 RVGLS 和 RVFWS，并通过整体纵向应变和 LV 射血分数评估 LV 收缩功能。患者随访 30.2 +/- 23.0 个月；主要终点是全因死亡/心力衰竭相关的住院治疗。通过 C 统计量和净重分类改善来评估预后表现。结果：随访期间发生了 95 起事件。通过单变量分析，RVGLS（风险比 x 1 SD，1.60；95% CI，1.29-1.99；P < .0001）和 RVFWS（风险比 x 1 SD，1.82；95% CI，1.45-2.29；P < .0001）均与结果相关，并且在校正 EMPHASIS 风险评分后两者仍然显着，New约克心脏协会课程、利钠肽和治疗。然而，在进一步校正 LV 收缩功能参数后，只有 RVFWS 仍与结果显着相关 (P < .01)。通过添加 RVFWS 改进了基本预测模型（净重分类改进 0.390；P < .05），但未添加 RVGLS。结论：虽然 RVGLS 和 RVFWS 均具有预后价值，但 RVFWS 可以更好地预测 HFrEF 患者的预后，主要是因为它受 LV 纵向功能障碍的影响较小。
Background: Global right ventricular (RV) longitudinal strain (RVGLS) and free wall RV longitudinal strain (RVFWS) have both been advocated as sensitive tools to evaluate RV function and predict prognosis in patients with heart failure and reduced ejection fraction (HFrEF). However, because the interventricular septum is an integral part of the left ventricle (LV) also, RVGLS might be influenced by LV dysfunction. Thus, we compared the prognostic performance of either RV strain parameter in HFrEF patients, also taking into account the degree of LV systolic dysfunction.Methods: In 288 prospectively enrolled outpatients with stable HFrEF, RVGLS and RVFWS were assessed by speckle-tracking and LV systolic function by global longitudinal strain and LV ejection fraction. Patients were followed up for 30.2 +/- 23.0 months; the primary endpoint was all-cause death/heart failure-related hospitalization. Prognostic performance was assessed by C-statistic and net reclassification improvement.Results: There were 95 events during follow-up. By univariable analysis, both RVGLS(hazard ratio x 1 SD, 1.60; 95% CI, 1.29-1.99; P < .0001) and RVFWS (hazard ratio x 1 SD, 1.82; 95% CI, 1.45-2.29; P < .0001) were associated with outcome, and both remained significant after correction for EMPHASIS risk score, New York Heart Association class, natriuretic peptides, and therapy. However, after further correction for LV systolic function parameters, only RVFWS remained significantly associated with outcome (P < .01). A basic prediction model was improved by adding RVFWS (net reclassification improvement 0.390; P < .05), but not RVGLS.Conclusions: Although both RVGLS and RVFWS have prognostic value, RVFWS better predicts outcome in HFrEF patients, mainly because it is less influenced by LV longitudinal dysfunction.