Characterization of Right Ventricular Remodeling in Pulmonary Hypertension Associated With Patient Outcomes by 3-Dimensional Wall Motion Tracking Echocardiography
Characterization of Right Ventricular Remodeling in Pulmonary Hypertension Associated With Patient Outcomes by 3-Dimensional Wall Motion Tracking Echocardiography
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DOI：
10.1161/circimaging.114.003176
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发表时间：
2015-06-01
影响因子：
7.5
通讯作者：
Gorcsan, John, III
中科院分区：
文献类型：
--
作者：
Ryo, Keiko;Goda, Akiko;Gorcsan, John, III
背景不良右心室（RV）重构对肺动脉高压（PH）患者具有显着的预后和治疗意义。然而，区分 RV 适应和与不良预后相关的不良重塑很困难。我们假设新型 3 维 (3D) 室壁运动跟踪超声心动图可以区分 RV 适应的形态学特征和预示着 PH 患者短期预后不良的不良重塑。方法和结果 - 我们研究了 112 名受试者：92 名 PH 患者和 20 名正常对照，采用 3D 室壁运动跟踪测量 RV 收缩末期容积指数 (ESVi)、RV 射血 分数 (EF) 和 RV 全局面积应变。 PH 患者还进行了有创血流动力学测量。压力-容量关系将 PH 患者分为 3 组，例如 RV 适应组、RV 适应重构组和 RV 逆向重构组。预定义的联合终点是 6 个月期间与肺PH相关的住院、死亡或肺部手术（肺移植或肺动脉内膜切除术）。正如预期的那样，92 名 PH 患者的 RV 体积显着大于正常对照，RVEF 和全面积应变较低。 PH 患者被归类为 RV 适应型 (ESVi, = 114 mL/m(2))：风险比，0.15； 95%置信区间，0.07至0.39； P<0.0001。 RV 不良重塑患者（ESVi，>= 114 mL/m(2)）的短期结果比 RV 适应重塑患者更差：风险比，2.2； 95%置信区间，0.91至5.39； P= 0.04。 结论 - PH 患者的定量 3D 超声心动图显示 RV 适应和重塑的形态学子集与临床结果相关。
Background-Adverse right ventricular (RV) remodeling has significant prognostic and therapeutic implications to patients with pulmonary hypertension (PH). However, differentiating RV adaption from adverse remodeling associated with poor outcomes is difficult. We hypothesized that novel 3-dimensional (3D) wall motion tracking echocardiography can differentiate morphological features of RV adaption from adverse remodeling heralding an unfavorable short-term prognosis in patients with PH.Methods and Results-We studied 112 subjects: 92 patients with PH and 20 normal controls with 3D wall motion tracking for RV end-systolic volume index (ESVi), RV ejection fraction (EF), and RV global area strain. Patients with PH also had invasive hemodynamic measurements. Pressure-volume relations classified patients with PH into 3 groups, such as RV adapted, RV adapted-remodeled, and RV adverse-remodeled. The predefined combined end point was PHrelated hospitalization, death, or lung surgery (lung transplantation or pulmonary endarterectomy) during 6 months. The 92 patients with PH had significantly larger RV volumes, lower RVEF and global area strain than normal controls as expected. Patients with PH classified as RV adapted (ESVi, = 114 mL/m(2)): hazard ratio, 0.15; 95% confidence intervals, 0.07 to 0.39; P< 0.0001. RV adverse-remodeled patients (ESVi, >= 114 mL/m(2)) had worse short-term outcome than the RV adapted-remodeled patients: hazard ratio, 2.2; 95% confidence interval, 0.91 to 5.39; P= 0.04.Conclusions-Quantitative 3D echocardiography in patients with PH demonstrated morphological subsets of RV adaption and remodeling associated with clinical outcomes.