Right ventricular function in heart failure with preserved ejection fraction: a community-based study.
Right ventricular function in heart failure with preserved ejection fraction: a community-based study.
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DOI：
10.1161/circulationaha.113.008461
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发表时间：
2014-12-23
期刊：
影响因子：
37.8
通讯作者：
Redfield MM
中科院分区：
文献类型：
--
作者：
Mohammed SF;Hussain I;AbouEzzeddine OF;Takahama H;Kwon SH;Forfia P;Roger VL;Redfield MM
心力衰竭和保留 EF (HFpEF) 患者中右心室 (RV) 收缩功能障碍 (RVD) 的患病率和临床意义尚不明确。来自明尼苏达州奥姆斯特德县的连续、前瞻性识别的 HFpEF（弗雷明汉 HF 标准，EF ≥ 50%）患者 (N=562) 在 HF 诊断时接受了超声心动图检查，并对原因特异性死亡率和 HF 住院情况进行了随访。 RV 功能按照三尖瓣环平面收缩期偏移 (TAPSE) 的三分位数和半定量（正常、轻度 RVD 或中重度 RVD）2D 评估进行分类。无论 RVD 是通过半定量评估还是 TAPSE ≤ 15 mm 来定义，合并 RVD 的 HFpEF 患者更有可能接受房颤、起搏器和慢性利尿治疗。超声检查显示，RVD 患者的 LVEF 稍低，舒张功能障碍更严重，血压和心输出量较低，肺动脉收缩压 (PASP) 较高，右心室扩大和三尖瓣关闭不全更严重。调整年龄、性别、PASP 和合并症后，半定量评估发现任何 RVD 的存在与较高的全因死亡率（风险比 (HR) = 1.35 (1.03-1.77；p=0.03)）和心血管死亡率（HR=1.85 (1.20-2.80；p=0.006)）和较高的首次死亡率（HR=1.99）相关。 (1.35-2.90；p=0.0006) 和倍数 (HR=1.81 (1.18-2.78；p=0.007) HF 住院率。由 TAPSE 值定义的 RVD 显示与死亡率和 HF 住院率相似但较弱的关联。在社区中，RVD 在 HFpEF 患者中很常见，与更严重 HF 的临床和超声心动图证据相关，并可预测较差的预后。
The prevalence and clinical significance of right ventricular (RV) systolic dysfunction (RVD) in patients with heart failure and preserved EF (HFpEF) are not well characterized. Consecutive, prospectively identified HFpEF (Framingham HF criteria, EF ≥50%) patients (N=562) from Olmsted County, Minnesota underwent echocardiography at HF diagnosis and follow-up for cause specific mortality and HF hospitalization. RV function was categorized by tertiles of tricuspid annular plane systolic excursion (TAPSE) and by semi-quantitative (normal, mild RVD or moderate-severe RVD) 2D assessment. Whether RVD was defined by semi-quantitative assessment or TAPSE ≤ 15 mm, HFpEF patients with RVD were more likely to have atrial fibrillation, pacemakers and chronic diuretic therapy. At echo, patients with RVD had slightly lower LVEF, worse diastolic dysfunction, lower blood pressure and cardiac output, higher pulmonary artery systolic pressure (PASP), and more severe RV enlargement and tricuspid valve regurgitation. Adjusting for age, sex, PASP and comorbidities, the presence of any RVD by semi-quantitative assessment was associated with higher all-cause (hazard ratio (HR) = 1.35 (1.03-1.77; p=0.03)) and cardiovascular (HR=1.85 (1.20-2.80; p=0.006)) mortality and higher first (HR=1.99 (1.35-2.90; p=0.0006) and multiple (HR=1.81 (1.18-2.78; p=0.007) HF hospitalization rates. RVD defined by TAPSE values showed similar but weaker associations with mortality and HF hospitalizations. In the community, RVD is common in HFpEF patients, associated with clinical and echocardiographic evidence of more advanced HF and predictive of poorer outcomes.