Prevalence of right ventricular dysfunction and prognostic significance in heart failure with preserved ejection fraction.
Prevalence of right ventricular dysfunction and prognostic significance in heart failure with preserved ejection fraction.
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DOI：
10.1007/s10554-020-01953-y
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发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
McCann GP
中科院分区：
文献类型：
--
作者：
Kanagala P;Arnold JR;Singh A;Khan JN;Gulsin GS;Gupta P;Squire IB;Ng LL;McCann GP
使用心血管磁共振成像 (CMR) 黄金标准描述射血分数保留型心力衰竭 (HFpEF) 右心室表现的数据很少。我们的目的是评估 HFpEF 中右心室收缩功能障碍 (RVD) 的比例及其与临床结果的关系。作为单中心、前瞻性、观察性研究的一部分，183 名受试者（135 名 HFpEF 和 48 名年龄和性别匹配的对照）接受了 CMR 的广泛表征。经胸超声心动图、血液采样和六分钟步行测试。对患者进行死亡或心力衰竭住院复合终点的随访。 RVD（定义为右心室射血分数 < 47%）对照存在于 19% 的 HFpEF 中。 RVD 患者更常出现收缩压降低、心房颤动、肺充血的影像学证据、心胸比升高和右心室容积增大。在中位随访 1429 天期间，47% (n = 64) 的 HFpEF 受试者经历了死亡 (n = 22) 或 HF 住院 (n = 42) 的复合终点。 RVD 与复合事件风险增加相关（Log-Rank p = 0.001）。在多变量 Cox 回归分析中，RVD 是不良结果的独立预测因子（调整后风险比 [HR] 3.946，95% CI 1.878–8.290，p = 0.0001）以及指数细胞外体积（HR 1.742，CI 1.176–2.579，p = 0.006）和E/E’（HR 1.745，CI 1.230–2.477，p = 0.002）。通过 CMR 评估，RVD 在近五分之一的 HFpEF 患者中普遍存在，并且与 HF 死亡和/或住院独立相关。该试验在 ClinicalTrials.gov 上进行了回顾性注册（标识符：NCT03050593）。注册日期为 2017 年 2 月 6 日。本文的在线版本 (10.1007/s10554-020-01953-y) 包含补充材料，可供授权用户使用。
There is a paucity of data characterizing right ventricular performance in heart failure with preserved ejection fraction (HFpEF) using the gold standard of cardiovascular magnetic resonance imaging (CMR). We aimed to assess the proportion of right ventricular systolic dysfunction (RVD) in HFpEF and the relation to clinical outcomes. As part of a single-centre, prospective, observational study, 183 subjects (135 HFpEF, and 48 age- and sex-matched controls) underwent extensive characterization with CMR. transthoracic echocardiography, blood sampling and six-minute walk testing. Patients were followed for the composite endpoint of death or HF hospitalization. RVD (defined as right ventricular ejection fraction < 47%) controls was present in 19% of HFpEF. Patients with RVD presented more frequently with lower systolic blood pressure, atrial fibrillation, radiographic evidence of pulmonary congestion and raised cardiothoracic ratio and larger right ventricular volumes. During median follow-up of 1429 days, 47% (n = 64) of HFpEF subjects experienced the composite endpoint of death (n = 22) or HF hospitalization (n = 42). RVD was associated with an increased risk of composite events (Log-Rank p = 0.001). In multivariable Cox regression analysis, RVD was an independent predictor of adverse outcomes (adjusted Hazard Ratio [HR] 3.946, 95% CI 1.878–8.290, p = 0.0001) along with indexed extracellular volume (HR 1.742, CI 1.176–2.579, p = 0.006) and E/E’ (HR 1.745, CI 1.230–2.477, p = 0.002). RVD as assessed by CMR is prevalent in nearly one-fifth of HFpEF patients and is independently associated with death and/or hospitalization with HF. The trial was registered retrospectively on ClinicalTrials.gov (Identifier: NCT03050593). The date of registration was February 06, 2017. The online version of this article (10.1007/s10554-020-01953-y) contains supplementary material, which is available to authorized users.
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