成人主动脉缩窄修复后右心室-肺动脉耦合的预后价值

IF 1.2 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
Alexander C. Egbe, William R. Miranda, Charles Jain, Heidi M. Connolly, Luke J. Burchill, Barry A. Borlaug
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引用次数: 0

摘要

背景:20%的成人修复主动脉缩窄(COA)患者存在右心室(RV)收缩功能障碍和肺动脉高压。然而,RV与肺动脉(RV- pa)耦合在该人群中的预后价值尚不清楚。本研究的目的是评估该人群中RV-PA偶联与临床结果(心力衰竭住院和全因死亡率)之间的关系。方法回顾性队列研究成人COA修复,右心室收缩功能正常,右心室游离壁应变≥- 24%。采用三尖瓣环形平面收缩偏移/RV收缩压(TAPSE/RVSP)比评估RV- pa耦合。结果509例患者中位年龄32岁[20-45];男性290例(57%),平均TAPSE和RVSP分别为22±5 mm和33±9 mmHg, TAPSE/RVSP比值为0.78 (0.56 ~ 0.96)mm/mmHg。509例患者中,51例(10%)死亡,43例(8%)因心力衰竭住院,中位随访时间为8.5年(4.9-10.4年)。在校正解剖病变、心血管干预、合共病和超声心动图指标后,TAPSE/RVSP与全因死亡率(风险比0.82,95%置信区间0.78-0.86,每0.1 mm/mmHg)和心力衰竭住院(风险比0.86,95%置信区间0.79-0.93,每0.1 mm/mmHg)相关。在风险模型中纳入TAPSE/RVSP比值提高了模型预测全因死亡率的预后能力(c -统计差异0.046,p <;心力衰竭住院(c -统计差异0.031,p = 0.007)。结论stapse /RVSP比值与右心室收缩功能正常的COA患者的预后相关,提示该人群在右心室明显收缩功能出现之前可能存在异常的RV- pa耦合。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prognostic value of right ventricular-pulmonary arterial coupling in adults with repaired coarctation of aorta

Background

Right ventricular (RV) systolic dysfunction and pulmonary hypertension is present in 20 % of adults with repaired coarctation of aorta (COA). However, the prognostic value of RV to pulmonary artery (RV-PA) coupling in this population is unknown. The purpose of this study was to assess the relationship between RV-PA coupling and clinical outcomes (heart failure hospitalization and all-cause mortality) in this population.

Methods

Retrospective cohort study of adults with repaired COA and normal RV systolic function defined as RV free wall strain ≥ -24 %. RV-PA coupling was assessed using tricuspid annular plane systolic excursion/RV systolic pressure (TAPSE/RVSP) ratio.

Results

Of 509 patients (median age 32 [20–45] years; men 290 [57 %]), the average TAPSE and RVSP were 22 ± 5 mm and 33 ± 9 mmHg, respectively, and TAPSE/RVSP ratio was 0.78 (0.56–0.96) mm/mmHg. Of 509 patients, 51 (10 %) died and 43 (8 %) were hospitalized for heart failure during a median follow-up of 8.5 (4.9–10.4) years. TAPSE/RVSP was associated with all-cause mortality (hazard ratio 0.82, 95 % confidence interval 0.78–0.86, per 0.1 mm/mmHg), and heart failure hospitalization (hazard ratio 0.86, 95 % confidence interval 0.79–0.93, per 0.1 mm/mmHg) after adjustment for anatomic lesions, cardiovascular interventions, comorbidities, and echocardiographic indices. The inclusion of TAPSE/RVSP ratio in the risk models improved prognostic power of the models to predict all-cause mortality (C-statistics difference 0.046, p < 0.001), and heart failure hospitalization (C-statistics difference 0.031, p = 0.007).

Conclusions

TAPSE/RVSP ratio was associated with outcomes in COA patients with normal RV systolic function, suggesting that abnormal RV-PA coupling may be present prior to the onset of overt RV systolic function in this population.
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来源期刊
International journal of cardiology. Congenital heart disease
International journal of cardiology. Congenital heart disease Cardiology and Cardiovascular Medicine
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