Cardiometabolic Risk Factors Associated With Right Ventricular Function and Compensation in Patients Referred for Echocardiography.
Cardiometabolic Risk Factors Associated With Right Ventricular Function and Compensation in Patients Referred for Echocardiography.
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DOI：
10.1161/jaha.122.028936
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发表时间：
2023-06-20
影响因子：
5.4
通讯作者：
Brittain, Evan L.
中科院分区：
文献类型：
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作者：
Morrison, Amanda M.;Huang, Shi;Annis, Jeffrey S.;Garry, Jonah D.;Hemnes, Anna R.;Freiberg, Matthew S.;Brittain, Evan L.
肺动脉高压和右心室（RV）功能障碍是不良结局的驱动因素;然而，RV功能障碍的可改变风险因素尚未得到很好的描述。我们在大量转诊人群中调查了代谢综合征临床标志物与超声心动图RV功能之间的相关性。使用电子健康记录数据，我们对2010年至2020年期间转诊接受经胸超声心动图检查的年龄≥18岁的患者进行了一项回顾性队列研究，这些患者具有RV收缩压（RVSP）或三尖瓣环平面收缩期偏移（TAPSE）值。肺动脉高压定义为RVSP >33 mm Hg，RV功能障碍定义为TAPSE ≤1.8 cm。我们的样本包括37203例患者，其中19495例（52%）为女性，29752例（83%）为白色，中位年龄为63岁（四分位距，51-73）。中位（四分位距）RVSP为30.0 mm Hg（24.0-38.7），中位TAPSE为2.1 cm（1.7-2.4）。在我们的样本中，40%记录到RVSP >33 mm Hg，32%记录到TAPSE <1.8 cm。RVSP从正常（<33 mm Hg）增加到轻度升高（33-39 mm Hg）或升高（>39 mm Hg）与低密度脂蛋白和高密度脂蛋白降低、血红蛋白A1 c和体重指数升高相关（P<0.001）。TAPSE >1.8 cm、TAPSE 1.5-1.8 cm和TAPSE <1.5 cm组之间的TAPSE降低与甘油三酯：高密度脂蛋白比率和血红蛋白A1 c升高以及体重指数、低密度脂蛋白、高密度脂蛋白和收缩压降低相关（P<0.001）。心脏代谢预测因子与RVSP和TAPSE之间的大多数关联是非线性的，具有与较高肺动脉压和较低RV功能相关的明确拐点。心脏代谢功能的临床指标与右心室功能和压力的超声心动图指标高度相关。
Pulmonary hypertension and right ventricular (RV) dysfunction are drivers of adverse outcomes; however, modifiable risk factors for RV dysfunction are not well described. We investigated the association between clinical markers of metabolic syndrome and echocardiographic RV function in a large referral population. Using electronic health record data, we performed a retrospective cohort study of patients aged ≥18 years referred for transthoracic echocardiography between 2010 and 2020 with RV systolic pressure (RVSP) or tricuspid annular plane systolic excursion (TAPSE) values. Pulmonary hypertension was defined by RVSP >33 mm Hg and RV dysfunction by TAPSE ≤1.8 cm. Our sample included 37 203 patients of whom 19 495 (52%) were women, 29 752 (83%) were White, with a median age of 63 years (interquartile range, 51–73). Median (interquartile range) RVSP was 30.0 mm Hg (24.0–38.7), and median TAPSE was 2.1 cm (1.7–2.4). Within our sample, 40% had recorded RVSP >33 mm Hg, and 32% with TAPSE <1.8 cm. Increase in RVSP from normal (<33 mm Hg) to mildly elevated (33–39 mm Hg) or elevated (>39 mm Hg) was associated with lower low‐density lipoprotein and high‐density lipoprotein, and higher hemoglobin A1c and body mass index (P<0.001). A decrease in TAPSE between groups of TAPSE >1.8 cm, TAPSE 1.5–1.8 cm, and TAPSE <1.5 cm was associated with increased triglyceride:high‐density lipoprotein ratio and hemoglobin A1c, and decreased body mass index, low‐density lipoprotein, high‐density lipoprotein, and systolic blood pressure (P<0.001). Most associations between cardiometabolic predictors and RVSP and TAPSE were nonlinear with clear inflection points associated with higher pulmonary pressure and lower RV function. Clinical measures of cardiometabolic function were highly associated with echocardiographic measures of right ventricular function and pressure.