三尖瓣反流患者与无三尖瓣反流患者基于右心室功能超声心动图的死亡率临界值对比。

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography Pub Date : 2025-03-01 DOI:10.1016/j.echo.2024.10.012

Lior Zornitzki MD , Ophir Freund MD , Shir Frydman MD , Zach Rozenbaum MD , Yoav Granot MD , Shmuel Banai MD , Yan Topilsky MD

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引用次数: 0

摘要

背景：三尖瓣-环状面-收缩期-扩张（TAPSE）和峰值-侧三尖瓣-环状面-收缩期-速度（S'）是右心室（RV）功能的超声心动图指标。这些参数的异常阈值是基于健康成人的数据，而不是结果数据：我们的目的是根据这些参数与连续患者死亡率的关系重新研究这些参数的异常阈值，并将患者分为有或无明显三尖瓣反流（TR）的分层：我们对 2011-2021 年间接受超声心动图检查的连续患者进行了回顾性分析。采用半定量方法对三尖瓣反流进行评估。在单变量和多变量 Cox 分析中，使用样条曲线评估了与超额死亡率相关的临界值：本次分析共纳入 24717 名受试者。1143名受试者（4.6%）具有临床意义（≥中度）的TR。在整个队列中，TAPSEC结论：与超额死亡率相关的 TAPSE 和 S'阈值高于健康成人中报告的阈值。与无明显TR的患者相比，有明显TR的患者与超额死亡率相关的TAPSE和S'临界值较低，这表明需要采用个性化的方法来解释它们。

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Mortality-Based Right Ventricle Functional Echocardiographic Cutoffs in Patients With Compared to Without Tricuspid Regurgitation

Background

Tricuspid annular plane systolic excursion (TAPSE) and peak lateral tricuspid annular systolic velocity (S’) are echocardiographic indices of right ventricle function. The abnormality thresholds for these parameters are based on data obtained from healthy adults rather than outcome data.

Objectives

We aimed to reexamine the abnormality thresholds for these parameters based on their association with mortality in consecutive patients, stratified to with or without significant tricuspid regurgitation (TR).

Methods

We performed a retrospective analysis of consecutive patients undergoing echocardiography between 2011 and 2021. Tricuspid regurgitation was assessed using a semiquantitative method. Cutoff values associated with excess mortality were assessed using spline curves in univariate and multivariate Cox analyses.

Results

A total of 24,717 subjects were included in the current analysis. A total of 1,143 (4.6%) subjects had clinically significant (moderate or more) TR. In the entire cohort, TAPSE <20.9 mm and S’ <10.9 cm/sec were associated with excess mortality. In subgroup analysis, among subjects with significant TR, TAPSE <18.0 mm and S' <10.0 cm/sec were the cutoffs associated with excess mortality, while subjects without TR had a higher cutoff of TAPSE <21.5 mm and S' <10.9 cm/sec. In a multivariate model adjusted for the presence of TR and baseline characteristics, TAPSE <20.9 mm (hazard ratio = 1.16; 95% CI, 1.10-1.23; P < .001) and S’ <10.9 cm/sec (hazard ratio =1.09; 95% CI, 1.04-1.20; P = .01) were independently associated with mortality.

Conclusions

The TAPSE and S’ thresholds associated with excess mortality are higher than those reported in healthy adults. The TAPSE and S′ cutoffs associated with excess mortality were lower in patients with significant TR compared to patients without, suggesting that a personalized approach for their interpretation is needed.

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来源期刊

Journal of the American Society of Echocardiography 医学-心血管系统

CiteScore

9.50

自引率

12.30%

发文量

257

审稿时长

66 days

期刊介绍： The Journal of the American Society of Echocardiography(JASE) brings physicians and sonographers peer-reviewed original investigations and state-of-the-art review articles that cover conventional clinical applications of cardiovascular ultrasound, as well as newer techniques with emerging clinical applications. These include three-dimensional echocardiography, strain and strain rate methods for evaluating cardiac mechanics and interventional applications.