Right Ventricular Strain for Prediction of Survival in Patients With Pulmonary Arterial Hypertension
Right Ventricular Strain for Prediction of Survival in Patients With Pulmonary Arterial Hypertension
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DOI：
10.1378/chest.10-2015
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发表时间：
2011-06-01
期刊：
影响因子：
9.6
通讯作者：
Kane, Garvan C.
中科院分区：
文献类型：
--
作者：
Sachdev, Arun;Villarraga, Hector R.;Kane, Garvan C.
背景资料：肺动脉高压（PAH）是一种肺血管重塑、右心衰竭和生存受限的毁灭性疾病。是否应变为基础的措施，右心室（RV）收缩功能预测未来的右侧心力衰竭和/或death是untested.Methods：RV纵向收缩应变和应变率进行了评价，超声心动图在80例世界卫生组织组1肺动脉高压（PH）（72%的功能分级[FC] III或IV）。结果：所有患者的右心室收缩期应变（-15% +/-5%）和应变率（-0.80 +/-0.29 s（-1））均降低。在评估的参数中，平均RV游离壁收缩应变差于-12.5%表明队列具有更严重的疾病（82%为FC III/IV）、更严重的RV收缩功能障碍（RV每搏输出量指数26 +/- 9 mL/m2）和更高的右心房压力（12 +/- 5 mm Hg）。RV游离壁应变差于-12.5%的患者与6个月内更大程度的疾病进展、更大程度的袢利尿剂需求和/或更大程度的下肢水肿相关，并且还预测了1年、2年、3年和4年死亡率（未校正的1年风险比，6.2; 2.1-22.3）。调整年龄，性别，PH原因，和FC后，患者有2.9倍的死亡率每5%的绝对下降，RV游离壁应变在1 year.Conclusions：无创评估RV纵向收缩应变和应变率独立预测未来的右心衰竭，临床恶化，PAH患者的死亡率。胸部2011;139（6）：1299-1309
Background: Pulmonary arterial hypertension (PAH) is a devastating illness of pulmonary vascular remodeling, right-sided heart failure, and limited survival. Whether strain-based measures of right ventricular (RV) systolic function predict future right-sided heart failure and/or death is untested.Methods: RV longitudinal systolic strain and strain rate were evaluated by echocardiography in 80 patients with World Health Organization group 1 pulmonary hypertension (PH) (72% were functional class [FC] III or IV). Survival status was assessed over 4 years.Results: All patients had a depressed RV systolic strain (-15% +/- 5%) and strain rate (-0.80 +/- 0.29 s(-1)). Of the parameters assessed, average RV free wall systolic strain worse than -12.5% identified a cohort with greater severity of disease (82% were FC III/IV), greater RV systolic dysfunction (RV stroke volume index 26 +/- 9 mL/m(2)), and higher right atrial pressure (12 +/- 5 mm Hg). Patients with an RV free wall strain worse than -12.5% were associated with a greater degree of disease progression within 6 months, a greater requirement for loop diuretics, and/or a greater degree of lower extremity edema, and it also predicted 1-, 2-, 3-, and 4-year mortality (unadjusted 1-year hazard ratio, 6.2; 2.1-22.3). After adjusting for age, sex, PH cause, and FC, patients had a 2.9-fold higher rate of death per 5% absolute decline in RV free wall strain at 1 year.Conclusions: Noninvasive assessment of RV longitudinal systolic strain and strain rate independently predicts future right-sided heart failure, clinical deterioration, and mortality in patients with PAH. CHEST 2011;139(6):1299-1309