Prognostic Implications and Reversibility of Pulmonary Vascular Resistance Derived by Echocardiography in Patients Undergoing Tricuspid Annuloplasty.

IF 6.7 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal - Cardiovascular Imaging Pub Date : 2024-11-06 DOI:10.1093/ehjci/jeae281
Jingnan Zhang, Frank A Flachskampf, Chi-Yan Zhu, Yan Chen, Meizhen Wu, Qingwen Ren, Jiayi Huang, Ran Guo, Wenli Gu, Yik-Ming Hung, Ferit Böyük, Fang Fang, Gejun Zhang, Xiangbin Pan, Yap-Hang Chan, Tai-Leung Chan, Kai-Hang Yiu
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Abstract

Background: Pulmonary vascular resistance (PVR) intimately correlates with right ventricular afterload and the development of secondary tricuspid regurgitation (sTR).

Objectives: We sought to investigate the prognostic roles of PVR derived by echocardiography in patients with sTR undergoing tricuspid annuloplasty (TA).

Methods: Data from 322 TA patients [median age (interquartile range): 65.0 (59.0-70.0) years; 35.7% males] were obtained from a prospective registry to determine the impact of PVR on the composite outcome (including all-cause mortality and heart failure hospitalization). PVR was calculated by dividing the peak TR velocity by time-velocity integral of the right ventricular outflow tract followed by adding 0.16.

Results: During a median follow-up of 5.2 years, 108 adverse events occurred including 48 deaths and 60 heart failure readmissions. Baseline PVR ≥2 WU was independently associated with a higher risk of composite outcome (HR:1.674, 95% CI: 1.028-2.726, P=0.038). Baseline PVR outperforms both pulmonary artery systolic pressure (PASP) and the ratio of tricuspid annulus plane systolic excursion to PASP in terms of outcome prediction, with pronounced improvement of global model fit, reclassification, and discrimination. In 150 patients who received short-term echocardiograms after surgery, the presence of postoperative PVR ≥2 WU (n=20, 13.3%) was independently associated with composite outcome (HR: 2.621, 95% CI: 1.292-5.319, P=0.008).

Conclusion: PVR derived by echocardiography is an independent determinant of outcomes in patients undergoing TA for sTR. The inclusion of noninvasive PVR may provide valuable information to improve patient selection and postoperative management in this population.

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三尖瓣瓣环成形术患者超声心动图得出的肺血管阻力的预后意义和可逆性
背景:肺血管阻力(PVR)与右心室后负荷和继发性三尖瓣反流(sTR)的发生密切相关:我们试图研究通过超声心动图得出的肺血管阻力对接受三尖瓣环成形术(TA)的继发性三尖瓣反流患者的预后作用:从一项前瞻性登记中获得了 322 名 TA 患者的数据(中位年龄(四分位数间距):65.0(59.0-70.0)岁;35.7% 为男性),以确定 PVR 对综合结果(包括全因死亡率和心衰住院率)的影响。PVR的计算方法是将TR峰值速度除以右心室流出道的时间-速度积分,再加上0.16:中位随访 5.2 年,共发生 108 起不良事件,包括 48 例死亡和 60 例心衰再住院。基线 PVR≥2 WU 与较高的综合结果风险独立相关(HR:1.674,95% CI:1.028-2.726,P=0.038)。在预后预测方面,基线 PVR 优于肺动脉收缩压(PASP)和三尖瓣环平面收缩期偏移与 PASP 的比值,全局模型拟合、再分类和辨别能力都有明显改善。在术后接受短期超声心动图检查的150名患者中,术后PVR≥2 WU(20人,13.3%)与综合结果独立相关(HR:2.621,95% CI:1.292-5.319,P=0.008):结论:超声心动图得出的 PVR 是因 sTR 而接受 TA 治疗的患者预后的独立决定因素。纳入无创 PVR 可为改善该人群的患者选择和术后管理提供有价值的信息。
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来源期刊
European Heart Journal - Cardiovascular Imaging
European Heart Journal - Cardiovascular Imaging CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
11.60
自引率
9.70%
发文量
708
审稿时长
4-8 weeks
期刊介绍: European Heart Journal – Cardiovascular Imaging is a monthly international peer reviewed journal dealing with Cardiovascular Imaging. It is an official publication of the European Association of Cardiovascular Imaging, a branch of the European Society of Cardiology. The journal aims to publish the highest quality material, both scientific and clinical from all areas of cardiovascular imaging including echocardiography, magnetic resonance, computed tomography, nuclear and invasive imaging. A range of article types will be considered, including original research, reviews, editorials, image focus, letters and recommendation papers from relevant groups of the European Society of Cardiology. In addition it provides a forum for the exchange of information on all aspects of cardiovascular imaging.
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