Right atrial to left atrial volume index ratio is associated with increased mortality in patients with pulmonary hypertension.
Right atrial to left atrial volume index ratio is associated with increased mortality in patients with pulmonary hypertension.
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DOI：
10.1111/echo.14149
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发表时间：
2018-11
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影响因子：
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通讯作者：
Mazimba S
中科院分区：
文献类型：
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作者：
Mysore MM;Bilchick KC;Ababio P;Ruth BK;Harding WC;Breathett K;Chadwell K;Patterson B;Mwansa H;Jeukeng CM;Kwon Y;Kennedy JLW;Mihalek AD;Mazimba S
肺动脉高压（PH）的特点是肺血管阻力增加，导致右心衰竭。右心房 (RA) 压力升高反映了右心室 (RV) 压力超负荷，并且是 PH 死亡的既定危险因素。我们假设 RA 与 LA 体积指数 RAVI/LAVI 之比增加的 PH 患者死亡率会增加。我们在调整 REVEAL 风险评分（肺动脉高压的既定风险评分）后，评估了在单个学术中心的肺动脉高压诊所就诊的 124 名患者的 RAVI/LAVI 与死亡率的关联。 LA 和 RA 体积指数由两名独立研究人员在四室和两室视图中测量。使用多变量逻辑回归对 RAVI/LAVI 与生存率的独立关联进行建模。在 124 名患者中（平均年龄 62 ± 12.7 岁，68.6% 为女性），RAVI/LAVI 每增加一个单位，死亡率就会增加近两倍（OR 1.91，95% Cl 1.20-3.04）。在多变量逻辑回归中，RAVI/LAVI 每增加一个单位，死亡率就会增加近两倍（OR 1.734，95% CI 1.003-2.998）。此外，与最低四分位数 (<0.77) 相比，最高四分位数 (>1.42) 的 RAVI/LAVI 与右心房压 (RAP) 与肺动脉楔压比 (RAP/PAWP) 升高显着相关 (0.76±0.41，p=0.02)，表明侵入性血流动力学数据、心房结构变化和 PH 死亡率之间存在相互作用。 PH 中 RAVI/LAVI 增加与生存率降低相关，并导致与侵入性血流动力学相关的心房结构重塑。这些发现支持对此进行进一步研究
Pulmonary hypertension (PH) is a characterized by increased pulmonary vascular resistance leading to right heart failure. Elevated right atrial (RA) pressure reflects right ventricular (RV) pressure overload and is an established risk factor for mortality in PH. We hypothesized that PH patients with an increased ratio of RA to LA volume index, RAVI/LAVI, would have increased mortality. We evaluated the association of RAVI/LAVI with mortality in 124 patients seen at a single academic center’s PH clinic after adjusting for the REVEAL risk score, an established risk score in PH. LA and RA volume indices were measured in the four and two chamber views by two independent researchers. Multivariable logistic regression was used to model the independent association of RAVI/LAVI with survival. Among 124 patients (mean age 62 ± 12.7 years, 68.6% female), each unit increase in RAVI/LAVI was associated with a nearly two-fold increase in mortality (OR 1.91, 95% Cl 1.20-3.04). In a multivariable logistic regression, each unit increase in RAVI/LAVI was associated with a nearly two-fold increase in mortality (OR 1.734, 95% CI 1.003-2.998). Furthermore, RAVI/LAVI in the highest quartile (>1.42) was significantly associated with elevated right atrial pressure (RAP) to pulmonary artery wedge pressure ratio (RAP/PAWP) (0.76±0.41, p=0.02) compared with the lowest quartile (<0.77), suggesting an interaction between invasive hemodynamic data, atrial structural changes, and mortality in PH. Increased RAVI/LAVI in PH is associated with decreased survival and accounts for atrial structural remodeling related to invasive hemodynamics. These findings support further study of this