[The influence of the interaction of right ventricle and pulmonary artery system on the development of adverse outcomes in acute decompensation of chronic heart failure].

IF 0.3 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Terapevticheskii Arkhiv Pub Date : 2025-04-15 DOI:10.26442/00403660.2025.03.203135

M R Islamova, A F Safarova, Z D Kobalava

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引用次数: 0

Abstract

Aim: To determine the frequency and prognostic significance of right ventricular-pulmonary artery (RV-PA) uncoupling, in the development of cardiovascular complications in patients with acute decompensation of chronic heart failure (ADCHF).

Materials and methods: The prospective single-center observational study included 171 patients with ADCHF. Tricuspid Annular Plane Systolic Excursion (TAPSE)/PA systolic pressure <0.36 mm/mmHg by 2D echocardiography was used as the indicator of the right ventricular-pulmonary artery RV-PA uncoupling.

Results: The incidence of RV-PA uncoupling in the general population of patients with ADCHF was 67.2% (n=129). Patients with RV-PA uncoupling had a more severe clinical status. RV-PA uncoupling was associated with male sex (odds ratio, OR 2.6, 95% CI 1.35-5.04; p=0.004), myocardial infarction (OR 2.06, 95% CI 1.04-4.09; p=0.037), and a history of cerebrovascular accident (OR 10.89, 95% CI 1.42-83.55; p=0.005). Echocardiography showed more pronounced deviations in the structural and functional parameters of the right and left heart compartments and a higher PA systolic pressure. In ischemic heart disease, the risk of RV-PA uncoupling increased 2.85 times (95% CI 0.99-8.23; p=0.053), and in diabetes mellitus, it increased 4.31 times (95% CI 1.19-15.56; p=0.026). With an increase in the diameter of the inferior vena cava per unit, the risk of RV-PA uncoupling increased 9.49 times (95% CI 2.17-41.40; p=0.003), and with an increase in the transverse size of the right atrium, it increased 2.83 times (95% CI 1.28-6.26; p=0.010). In patients with RV-PA uncoupling, higher liver density was identified using transient elastography and reduced active and reactive resistance using bioimpedance vector analysis, regardless of right ventricular dysfunction. The effect of the RV-PA uncoupling on the overall hospitalization rate and related to ADCHF was shown.

Conclusion: The high frequency, clinical association, and prognostic significance of RV-PA uncoupling support RV-PA assessment in patients with ADCHF.

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[右心室和肺动脉系统相互作用对慢性心力衰竭急性失代偿不良结局发展的影响]。

目的：探讨右心室-肺动脉（RV-PA）解耦在慢性心力衰竭（ADCHF）急性失代偿患者心血管并发症发生中的频率及预后意义。材料和方法：前瞻性单中心观察研究纳入171例ADCHF患者。结果：ADCHF患者一般人群中RV-PA解耦的发生率为67.2% （n=129）。RV-PA解耦患者的临床状况更为严重。RV-PA解耦与男性相关(优势比OR 2.6, 95% CI 1.35-5.04；p=0.004)，心肌梗死(OR 2.06, 95% CI 1.04-4.09；p=0.037)，脑血管意外史(OR 10.89, 95% CI 1.42-83.55；p = 0.005)。超声心动图显示左、右心室结构和功能参数偏差更明显，PA收缩压升高。在缺血性心脏病中，RV-PA解耦的风险增加2.85倍(95% CI 0.99-8.23；p=0.053)，糖尿病患者则增加4.31倍(95% CI 1.19-15.56；p = 0.026)。随着单位下腔静脉直径的增加，RV-PA分离的风险增加9.49倍(95% CI 2.17-41.40；p=0.003)，随着右心房横向尺寸的增加，右心房横向尺寸增加2.83倍(95% CI 1.28 ~ 6.26；p = 0.010)。在RV-PA解耦的患者中，无论右室功能是否紊乱，通过瞬态弹性成像可以识别出更高的肝脏密度，通过生物阻抗矢量分析可以识别出活性和反应性阻力降低。RV-PA解耦对总住院率的影响及与ADCHF的关系。结论：RV-PA解耦的高频率、临床相关性和预后意义支持ADCHF患者的RV-PA评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Terapevticheskii Arkhiv 医学-医学：内科

CiteScore

1.40

自引率

33.30%

发文量

171

审稿时长

3-8 weeks

期刊介绍： Терапевтический архив The journal was founded by the prominent Russian therapists M.P. Konchalovsky and G.F. Lang in 1923. Then its editors-in-chief were Professors V.N. Vinogradov and A.G. Gukasyan. Since 1972, E.I. Chazov, Academician of the Russian Academy of Sciences, has been heading the editorial board of the journal. Over 90 years, there have been more than 1000 issues where the authors and editorial staff have done their best for readers to keep abreast of current advances in medical science and practice and for physicians to master the advanced principles of recognition and treatment of a wide spectrum of visceral diseases. The papers published in the journal (editorials, original articles, lectures, reviews, etc.) cover both current scientific achievements and practical experience in diagnosing, treating, and preventing visceral diseases. The authors of publications are not only Russian, but also foreign scientists and physicians. All papers are peer-reviewed by highly qualified Russian specialists. The journal is published monthly. Traditionally, each issue has predominantly certain thematic areas covering individual therapy specializations. Every year, one of the issues is devoted to related problems in practical medicine (allergology and immunology, neurology and psychiatry, obstetrics, oncology, etc.). This all draws the attention of the reading public to the journal. The journal is indexed in RSCI (Russian Science Citation Index), PubMed/Medline, Index Medicus, Scopus/EMBASE, Web of Science Core Collection (Science Citation Index Expanded), Web of Science (Russian Science Citation Index - RSCI, Current Contents Connect, BIOSIS Previews), Google Scholar, Ulrich''s Periodicals Directory. The journal is included in the list of periodicals recommended by the Higher Attestation Committee for publishing the papers containing the basic materials of doctoral and candidate dissertations. By the decision of the Presidium of the Russian Academy of Medical Sciences, the “Therapevticheskiy Arkhiv” was awarded the Botkin medal. It was admitted to the European Association of Sciences Editors (EASE). The journal was honored with the Golden Press Fund decoration at the 13th International Press Professional Exhibition.