Moving Beyond Right Ventricular Ejection Fraction: Incremental Prognostic Role of Right Ventricular Strain on Postcardiac Transplant Outcomes.
Moving Beyond Right Ventricular Ejection Fraction: Incremental Prognostic Role of Right Ventricular Strain on Postcardiac Transplant Outcomes.
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超越右心室射血分数：右心室应变对心脏移植结果的增量预后作用。
DOI：
10.1161/circimaging.124.016789
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发表时间：
2024
期刊：
影响因子：
--
通讯作者：
Kim,Jiwon
中科院分区：
文献类型：
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作者：
Owyang,ClarkG;Kim,Jiwon
在本期《循环：心血管成像》中，Barrett 等人6 解决了有关稳定心脏移植患者中右心室功能的预后作用的重要问题。在这项对 257 名连续心脏移植受者进行的回顾性队列研究中，他们接受了心血管磁共振 (CMR) 以常规监测同种异体移植物血管病变和功能障碍，通过 RV 射血分数 (RVEF) 和 RV 整体纵向应变 (RVGLS) 两种主要方法研究 RV 功能。中位随访时间为 4.4 年，108 名患者达到了研究的综合结果，即全因死亡率或主要不良心脏事件，包括再移植、心肌梗死、冠状动脉血运重建和心力衰竭住院治疗。与右心室功能障碍相关，在 74 例死亡中，36%（n=27）被认为是由于心血管原因造成的，其余的是非心血管原因。此外，50 名患者因心力衰竭住院，9 名患者接受了再移植。在多变量 Cox 回归分析中，尽管 RVEF 与结果不独立相关，但 RVGLS 与死亡或主要不良心脏事件相关，即使在控制左心室功能后也是如此。就机制而言，心脏移植后右心室功能障碍可能由多种因素引起，包括排斥反应、肺动脉高压和同种异体心脏移植血管病变。在 Barrett 等人的这项研究中，虽然在对 231 名接受右心导管插入术的患者进行的亚组分析中，近三分之一（31%；n=71）患有肺动脉高压，但并未直接研究导致亚临床右心室功能障碍的 6 种机制。在肺动脉高压患者中，大多数患有毛细血管后肺动脉高压
In this issue of Circulation: Cardiovascular Imaging, Barrett et al6 address important questions regarding the prognostic role of RV function in stable cardiac transplantation patients. In this retrospective cohort study of 257 consecutive heart transplant recipients undergoing cardiovascular magnetic resonance (CMR) for routine surveillance of allograft vasculopathy and dysfunction, RV function is studied via 2 primary methodologies, RV ejection fraction (RVEF) and RV global longitudinal strain (RVGLS). At a median follow-up of 4.4 years, 108 patients met the study composite outcome of all-cause mortality or major adverse cardiac events including retransplantation, myocardial infarction, coronary revascularization, and heart failure hospitalization. Of relevance to RV dysfunction, of the 74 deaths, 36%(n= 27) were deemed to be due to a cardiovascular cause and the remainder were noncardiovascular. Additionally, 50 patients had heart failure hospitalization and 9 underwent retransplantation. On multivariable Cox regression analysis, whereas RVEF was not independently associated with outcomes, RVGLS was linked to death or major adverse cardiac events, even after controlling for LV function. With respect to mechanisms, RV dysfunction following cardiac transplantation can occur due to a variety of factors including rejection, pulmonary hypertension, and cardiac allograft vasculopathy. In this study by Barrett et al, 6 mechanisms contributing to subclinical RV dysfunction are not directly studied, though in a subgroup analysis of 231 patients undergoing right heart catheterization, nearly a third (31%; n= 71) had pulmonary hypertension. Among patients with pulmonary hypertension, the majority had postcapillary pulmonary hypertension