L. Trousselle , F. Eggenspieler , L. Faroux , P. Nazeyrollas , O. Huttin , N. Pace , L. Filippetti , A. Fraix , B. Carquin , C. Selton-Suty , D. Metz
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Combined parameters of function and load (TAPSE/PASP, TR TVI<!--> <!-->×<!--> <!-->RVFWS), morphology and load (load adaptation index<!--> <!-->=<!--> <!-->TRTVIxRVED length/area) and morphology, load, and function [myomechanical index (MMI<!--> <!-->=<!--> <!-->RV-RA mean pressure gradient<!--> <!-->×<!--> <!-->RVFWS/indexed RAED area<!--> <!-->×<!--> <!-->10–2) and morphology-load-function index (MLF<!--> <!-->=<!--> <!-->RVED length/area xTRTVIx RVFWS)] were calculated. We used ROC curves to analyze the diagnostic value of echocardiographic parameters to predict potential high (><!--> <!-->3) or low (<<!--> <!-->6) surgical risk of mortality according to TRISCORE.</p></div><div><h3>Results</h3><p>Simple parameters were significatively different among groups with a nonlinear progression between the 5 levels of TR. Combined parameters were also significatively different. Among them, MMI and MLF had a linear progression (MMI: grade 1: 0.20<!--> <!-->±<!--> <!-->0.09; grade 2: 0.15<!--> <!-->±<!--> <!-->0.08; grade 3: 0.10<!--> <!-->±<!--> <!-->0.05, grade 4: 0.09<!--> <!-->±<!--> <!-->0.08; grade 5: 0.05<!--> <!-->±<!--> <!-->0.04 <em>P</em> <em>=</em> <!-->0.000; MLF: grade 1: 7.56<!--> <!-->±<!--> <!-->2.06; grade 2: 6.57<!--> <!-->±<!--> <!-->2.14; grade 3: 4.85<!--> <!-->±<!--> <!-->2.29, grade 4: 4.79<!--> <!-->±<!--> <!-->3.17; grade 5: 3.06<!--> <!-->±<!--> <!-->1.82 <em>P</em> <em>=</em> <!-->0.000) and had the best predictive value for TRISCORE (MMI: AUC<!--> <!-->=<!--> <!-->0.889 <em>P</em> <em>=</em> <!-->0.000 for low risk, 0.855 <em>P</em> <em>=</em> <!-->0.000 for high risk; MLF: AUC<!--> <!-->=<!--> <!-->0.873 <em>P</em> <em>=</em> <!-->0.000 and 0.822 <em>P</em> <em>=</em> <!-->0.000).</p></div><div><h3>Conclusion</h3><p>Combined parameters are relevant to evaluate cardiopulmonary unit in a population presenting with TR, especially when combining morphology, function and load (<span>Fig. 1</span>).</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":null,"pages":null},"PeriodicalIF":18.0000,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Echocardiographic assessment of right ventricular function and right ventriculoarterial coupling in tricuspid regurgitation\",\"authors\":\"L. Trousselle , F. Eggenspieler , L. Faroux , P. Nazeyrollas , O. Huttin , N. Pace , L. Filippetti , A. Fraix , B. Carquin , C. Selton-Suty , D. Metz\",\"doi\":\"10.1016/j.acvdsp.2023.04.032\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>Echographic evaluation of the cardiopulmonary unit may be difficult in the presence of TR. Purpose: To assess the variation of simple and combined echographic parameters analysing the cardiopulmonary unit according to the severity of TR.</p></div><div><h3>Method</h3><p>Echographic images were reviewed in 179 patients to assess TR grade according to Hahn's 5 grades classification. Classical morphological (RV end diastolic length and area), function [TAPSE, RVFAC, S’,RVFWS (RV free wall longitudinal strain)] and load [PASP,TRTVI (TR Time-velocity integral)] parameters analysing RV were assessed. Combined parameters of function and load (TAPSE/PASP, TR TVI<!--> <!-->×<!--> <!-->RVFWS), morphology and load (load adaptation index<!--> <!-->=<!--> <!-->TRTVIxRVED length/area) and morphology, load, and function [myomechanical index (MMI<!--> <!-->=<!--> <!-->RV-RA mean pressure gradient<!--> <!-->×<!--> <!-->RVFWS/indexed RAED area<!--> <!-->×<!--> <!-->10–2) and morphology-load-function index (MLF<!--> <!-->=<!--> <!-->RVED length/area xTRTVIx RVFWS)] were calculated. We used ROC curves to analyze the diagnostic value of echocardiographic parameters to predict potential high (><!--> <!-->3) or low (<<!--> <!-->6) surgical risk of mortality according to TRISCORE.</p></div><div><h3>Results</h3><p>Simple parameters were significatively different among groups with a nonlinear progression between the 5 levels of TR. Combined parameters were also significatively different. Among them, MMI and MLF had a linear progression (MMI: grade 1: 0.20<!--> <!-->±<!--> <!-->0.09; grade 2: 0.15<!--> <!-->±<!--> <!-->0.08; grade 3: 0.10<!--> <!-->±<!--> <!-->0.05, grade 4: 0.09<!--> <!-->±<!--> <!-->0.08; grade 5: 0.05<!--> <!-->±<!--> <!-->0.04 <em>P</em> <em>=</em> <!-->0.000; MLF: grade 1: 7.56<!--> <!-->±<!--> <!-->2.06; grade 2: 6.57<!--> <!-->±<!--> <!-->2.14; grade 3: 4.85<!--> <!-->±<!--> <!-->2.29, grade 4: 4.79<!--> <!-->±<!--> <!-->3.17; grade 5: 3.06<!--> <!-->±<!--> <!-->1.82 <em>P</em> <em>=</em> <!-->0.000) and had the best predictive value for TRISCORE (MMI: AUC<!--> <!-->=<!--> <!-->0.889 <em>P</em> <em>=</em> <!-->0.000 for low risk, 0.855 <em>P</em> <em>=</em> <!-->0.000 for high risk; MLF: AUC<!--> <!-->=<!--> <!-->0.873 <em>P</em> <em>=</em> <!-->0.000 and 0.822 <em>P</em> <em>=</em> <!-->0.000).</p></div><div><h3>Conclusion</h3><p>Combined parameters are relevant to evaluate cardiopulmonary unit in a population presenting with TR, especially when combining morphology, function and load (<span>Fig. 1</span>).</p></div>\",\"PeriodicalId\":8140,\"journal\":{\"name\":\"Archives of Cardiovascular Diseases Supplements\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":18.0000,\"publicationDate\":\"2023-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Archives of Cardiovascular Diseases Supplements\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1878648023001714\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Cardiovascular Diseases Supplements","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1878648023001714","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
目的:评价单纯超声和综合超声参数的变化，根据TR的严重程度对心肺进行分析。方法回顾性分析179例患者的超声图像，根据Hahn的5级分级对TR进行分级。分析右心室的经典形态学参数(右心室舒张末端长度和面积)、功能参数[TAPSE、RVFAC、S '、RVFWS(右心室自由壁纵向应变)]和载荷参数[PASP、TRTVI(右心室时间-速度积分)]。计算功能与载荷(TAPSE/PASP, TRTVI × RVFWS)、形态与载荷(载荷适应指数= TRTVIxRVED长度/面积)、形态、载荷与功能[肌力学指数(MMI = RV-RA平均压力梯度× RVFWS/索引RAED面积× 10-2)和形态-载荷-功能指数(MLF = RVED长度/面积xTRTVIx RVFWS)]的组合参数。我们采用ROC曲线分析超声心动图参数对预测潜在高(>3)或低(<6)根据TRISCORE评估手术死亡风险。结果单纯参数组间差异有统计学意义，5个TR水平间呈非线性变化，综合参数组间差异也有统计学意义。其中，MMI与MLF呈线性进展(MMI: 1级:0.20±0.09;2级:0.15±0.08;3级:0.10±0.05,4级:0.09±0.08;5级:0.05±0.04 P = 0.000;MLF: 1级:7.56±2.06;二级:6.57±2.14;三级:4.85±2.29，四级:4.79±3.17;5级:3.06±1.82 P = 0.000)，对TRISCORE的预测值最高(MMI: AUC = 0.889 P = 0.000，低危、高危分别为0.855 P = 0.000;MLF: AUC = 0.873 P = 0.000和0.822 P = 0.000)。结论综合参数与评估TR人群的心肺功能相关，特别是结合形态学、功能和负荷时(图1)。
Echocardiographic assessment of right ventricular function and right ventriculoarterial coupling in tricuspid regurgitation
Introduction
Echographic evaluation of the cardiopulmonary unit may be difficult in the presence of TR. Purpose: To assess the variation of simple and combined echographic parameters analysing the cardiopulmonary unit according to the severity of TR.
Method
Echographic images were reviewed in 179 patients to assess TR grade according to Hahn's 5 grades classification. Classical morphological (RV end diastolic length and area), function [TAPSE, RVFAC, S’,RVFWS (RV free wall longitudinal strain)] and load [PASP,TRTVI (TR Time-velocity integral)] parameters analysing RV were assessed. Combined parameters of function and load (TAPSE/PASP, TR TVI × RVFWS), morphology and load (load adaptation index = TRTVIxRVED length/area) and morphology, load, and function [myomechanical index (MMI = RV-RA mean pressure gradient × RVFWS/indexed RAED area × 10–2) and morphology-load-function index (MLF = RVED length/area xTRTVIx RVFWS)] were calculated. We used ROC curves to analyze the diagnostic value of echocardiographic parameters to predict potential high (> 3) or low (< 6) surgical risk of mortality according to TRISCORE.
Results
Simple parameters were significatively different among groups with a nonlinear progression between the 5 levels of TR. Combined parameters were also significatively different. Among them, MMI and MLF had a linear progression (MMI: grade 1: 0.20 ± 0.09; grade 2: 0.15 ± 0.08; grade 3: 0.10 ± 0.05, grade 4: 0.09 ± 0.08; grade 5: 0.05 ± 0.04 P= 0.000; MLF: grade 1: 7.56 ± 2.06; grade 2: 6.57 ± 2.14; grade 3: 4.85 ± 2.29, grade 4: 4.79 ± 3.17; grade 5: 3.06 ± 1.82 P= 0.000) and had the best predictive value for TRISCORE (MMI: AUC = 0.889 P= 0.000 for low risk, 0.855 P= 0.000 for high risk; MLF: AUC = 0.873 P= 0.000 and 0.822 P= 0.000).
Conclusion
Combined parameters are relevant to evaluate cardiopulmonary unit in a population presenting with TR, especially when combining morphology, function and load (Fig. 1).
期刊介绍：
Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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