Right Ventricular Longitudinal Strain Predicts Survival in Patients With Functional Tricuspid Regurgitation
Right Ventricular Longitudinal Strain Predicts Survival in Patients With Functional Tricuspid Regurgitation
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DOI：
10.1016/j.cjca.2021.01.006
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发表时间：
2021-07-13
影响因子：
6.2
通讯作者：
Butter, Christian
中科院分区：
文献类型：
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作者：
Bannehr, Marwin;Kahn, Ulrike;Butter, Christian
背景：功能性三尖瓣返流（TR）是超声心动图常见的结果。尽管普遍认为右心室（RV）功能障碍影响TR患者的预后，但仍不清楚哪些超声心动图参数最准确地反映预后。在这项研究中，我们的目的是评估RV功能障碍的患病率和TR患者的预后价值。方法：从1089例连续患者的数据进行了分析。三尖瓣环平面收缩期偏移（TAPSE）、面积变化分数和右心室游离壁纵向应变（RV应变）用于定义RV功能障碍。随访患者2年全因死亡率。结果：13.9%的患者无TR，61.2%的患者有轻度TR，19.6%的患者有中度TR，5.3%的患者有重度TR。TR分级与死亡率增加相关（对数秩，P < 0.001）。RV应变受损和TAPSE是死亡率的独立预测因素（RV：风险比[HR]，1.130; 95%置信区间[CI]，1.099-1.160; P < 0.001; TAPSE：HR，1.131; 95% CI，1.085-1.175; P < 0.001）。RV毒株和TAPSE均改善了生存预测的参考模型（RV：综合辨别力改善[IDI]，0.184; 95%CI，0.146-0.221; P < 0.001; TAPSE：IDI，0.057; 95%CI，0.037-0.077; P < 0.001）。超声心动图评价右室功能似乎对TR患者有用。RV毒株的评估为预测2年死亡率提供了额外的价值。
Background: Functional tricuspid regurgitation (TR) is a frequent finding in echocardiography. Despite general consent that right ventricular (RV) dysfunction impacts outcome of patients with TR, it is still unknown which echocardiographic parameters most accurately reflect prognosis. In this study we aimed to evaluate the prevalence of RV dysfunction and its prognostic value in patients with TR.Methods: Data from 1089 consecutive patients were analysed. Tricuspid annular plane systolic excursion (TAPSE), fractional area change, and right ventricular free wall longitudinal strain (RV strain) were used to define RV dysfunction. Patients were followed for 2-year all-cause mortality. For prediction of survival, reclassification and C statistics of RV functional parameters using TR grade as reference model were performed.Results: Among the patients studied, 13.9% showed no TR, 61.2% had mild TR, 19.6% had moderate TR, and 5.3% had severe TR. The TR grade was associated with increased mortality (log rank, P < 0.001). Impaired RV strain and TAPSE were independent predictors for mortality (RV: hazard ratio [HR], 1.130; 95% confidence interval [CI], 1.099-1.160; P < 0.001; TAPSE: HR, 1.131; 95% CI, 1.085-1.175; P < 0.001). Both RV strain and TAPSE improved the reference model for survival prediction (RV: integrated discrimination improvement [IDI], 0.184; 95% CI, 0.146-0.221; P < 0.001; TAPSE: IDI, 0.057; 95% CI, 0.037-0.077; P < 0.001).Conclusions: Echocardiographic evaluation of RV function appears to useful for patients with TR. Assessment of RV strain provides additional value for prediction of 2-year mortality.