TAPSE/PASP比值评估右室-肺动脉耦合在急性心力衰竭患者预后中的作用。

Q2 Medicine

Journal of Cardiovascular Imaging Pub Date : 2023-10-01 DOI:10.4250/jcvi.2023.0055

Youngnam Bok, Ji-Yeon Kim, Jae-Hyeong Park

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TAPSE/PASP ratio exhibited significant correlations with left ventricular (LV) ejection fraction(r = 0.243, p < 0.001), left atrial (LA) diameter(r = −0.320, p < 0.001), left atrial global longitudinal strain (LAGLS, r = 0.496, p < 0.001), mitral E/E′ ratio(r = −0.337, p < 0.001), and right ventricular fractional area change (RVFAC, r = 0.496, p < 0.001). During the median follow-up duration of 29.0 months, a total of 387 patients (33.7%) died. In the univariate analysis, PASP, TAPSE, and TAPSE/PASP ratio were significant predictors of mortality. After the multivariate analysis, TAPSE/PASP ratio remained a statistically significant parameter for all-cause mortality (hazard ratio [HR], 0.453; p = 0.037) after adjusting for other parameters. In the receiver operating curve analysis, the optimal cut-off level of TAPSE/PASP ratio for predicting mortality was 0.33 (area under the curve = 0.576, p < 0.001), with a sensitivity of 65% and a specificity of 47%. 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引用次数: 1

摘要

背景：右心室功能障碍是急性心力衰竭（AHF）患者发生重大心脏不良事件的重要风险。在本研究中，我们通过三尖瓣环平面收缩偏移（TAPSE）/肺动脉收缩压（PASP）评估了AHF患者的RV-肺动脉（PA）耦合，并评估了其预后意义。方法：测量TAPSE/PASP比值，并分析其与其他超声心动图参数的相关性。此外，我们评估了其在AHF患者中的预后作用。结果：共有1147名患者纳入分析（575名男性，年龄70.81±13.56岁）。TAPSE/PASP比值与左心室（LV）射血分数（r=0.243，p＜0.001）、左心房（LA）直径（r=-0.320，p＜0.01）、左房整体纵向应变（LAGLS，r=0.496，p＜001）、二尖瓣E/E’比值（r=-0.337，p＜.001）显著相关，右心室部分面积变化（RVFAC，r=0.496，p<0.001）。在中位随访29.0个月期间，共有387名患者（33.7%）死亡。在单因素分析中，PASP、TAPSE和TAPSE/PASP比率是死亡率的重要预测因素。多变量分析后，TAPSE/PASP比率在调整其他参数后仍然是全因死亡率的一个具有统计学意义的参数（危险比[HR]，0.453；p=0.037）。在受试者工作曲线分析中，TAPSE/PASP比率预测死亡率的最佳截止水平为0.33（曲线下面积=0.576，p＜0.001），敏感性为65%，特异性为47%。调整其他变量后，TAPSE/PASP比值<0.33与死亡率增加相关（HR，1.306；p=0.025）。结论：在AHF患者中，TAPSE/PASP比值与RVFAC、LA直径和LAGLS显著相关。此外，TAPSE/PASP比值降低<0.33被确定为死亡率的不良预后因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Prognostic Role of Right Ventricular-Pulmonary Artery Coupling Assessed by TAPSE/PASP Ratio in Patients With Acute Heart Failure.

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Prognostic Role of Right Ventricular-Pulmonary Artery Coupling Assessed by TAPSE/PASP Ratio in Patients With Acute Heart Failure.

BACKGROUND Right ventricular (RV) dysfunction is a significant risk of major adverse cardiac events in patients with acute heart failure (AHF). In this study, we evaluated RV-pulmonary artery (PA) coupling, assessed by tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) and assessed its prognostic significance, in AHF patients. METHODS We measured the TAPSE/PASP ratio and analyzed its correlations with other echocardiographic parameters. Additionally, we assessed its prognostic role in AHF patients. RESULTS A total of 1147 patients were included in the analysis (575 men, aged 70.81 ± 13.56 years). TAPSE/PASP ratio exhibited significant correlations with left ventricular (LV) ejection fraction(r = 0.243, p < 0.001), left atrial (LA) diameter(r = −0.320, p < 0.001), left atrial global longitudinal strain (LAGLS, r = 0.496, p < 0.001), mitral E/E′ ratio(r = −0.337, p < 0.001), and right ventricular fractional area change (RVFAC, r = 0.496, p < 0.001). During the median follow-up duration of 29.0 months, a total of 387 patients (33.7%) died. In the univariate analysis, PASP, TAPSE, and TAPSE/PASP ratio were significant predictors of mortality. After the multivariate analysis, TAPSE/PASP ratio remained a statistically significant parameter for all-cause mortality (hazard ratio [HR], 0.453; p = 0.037) after adjusting for other parameters. In the receiver operating curve analysis, the optimal cut-off level of TAPSE/PASP ratio for predicting mortality was 0.33 (area under the curve = 0.576, p < 0.001), with a sensitivity of 65% and a specificity of 47%. TAPSE/PASP ratio < 0.33 was associated with an increased risk of mortality after adjusting for other variables (HR, 1.306; p = 0.025). CONCLUSIONS In AHF patients, TAPSE/PASP ratio demonstrated significant associations with RVFAC, LA diameter and LAGLS. Moreover, a decreased TAPSE/PASP ratio < 0.33 was identified as a poor prognostic factor for mortality.

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来源期刊

Journal of Cardiovascular Imaging Medicine-Cardiology and Cardiovascular Medicine

CiteScore

3.40

自引率

0.00%

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