功能性三尖瓣反流患者右心重塑的四维自动定量超声心动图评估。

IF 2.9 2区 医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Quantitative Imaging in Medicine and Surgery Pub Date : 2024-10-01 Epub Date: 2024-09-26 DOI:10.21037/qims-24-676
Yongzhi Cai, Xiaofeng Zhang, Tongtong Huang, Xiaoju Luo, Decai Zeng, Shuai Chang, Liuliu Huang, Yue Li, Ji Wu
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引用次数: 0

摘要

背景:功能性三尖瓣反流(FTR)与右心重塑存在病理生理学联系。鉴于近年来对右心房重塑的关注日益增加,全面研究右心重塑的各个方面对于了解 FTR 的进展和治疗至关重要。在科学文献中,缺乏对 FTR 患者右心房重塑的全面探讨,也没有关于这种重塑程度与三尖瓣反流(TR)严重程度之间潜在相关性的报道。本研究旨在评估四维(4D)自动定量超声心动图测量的右心参数与 FTR 患者三尖瓣反流严重程度之间的关系:在这项前瞻性病例对照研究中,前瞻性地连续选取了2022年2月至2023年3月期间在广西医科大学第一附属医院经超声心动图确诊为FTR的100名患者作为病例组,其中包括50名轻度FTR患者和50名中度或重度FTR患者。此外,30 名健康参与者作为对照组。采用常规超声心动图获取二维(2D)和三维(3D)图像,然后进行四维自动定量超声心动图评估。方差分析(ANOVA)或Kruskal-Wallis检验用于比较组间差异,皮尔逊相关系数分析用于鉴别参数与TR体积之间的关系,多变量线性回归用于识别与TR体积相关的因素,逻辑回归用于预测FTR的严重程度:病例组包括 50 名轻度 FTR 患者(26 名男性,占 52%;年龄范围为 31-78 岁;平均年龄 ± SD:58±11.4 岁)和 50 名中重度 FTR 患者(21 名男性,占 42%;年龄范围为 29-87 岁;平均年龄 ± SD:60±13.0 岁)。此外,30 名健康参与者(13 名男性,占 43%;年龄范围为 19-81 岁;平均年龄(± SD):58±13.3 岁)组成对照组。中重度 FTR 患者有明显的右心扩张和功能衰退。TR容积与右心房最小容积(RAVmin;r=0.864;PC结论)高度相关:四维自动定量超声心动图可对右心容积和功能进行动态评估。要确定 FTR 的发展,右心房扩张似乎比右心室扩张更重要。RASr、RAScd 和 RASr-c 与 FTR 的严重程度直接相关。
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Four-dimensional automated quantitative echocardiography assessment of right heart remodeling in patients with functional tricuspid regurgitation.

Background: Functional tricuspid regurgitation (FTR) has a pathophysiological connection with right heart remodeling. Given the increasing focus on right atrial remodeling in recent years, a comprehensive study of all aspects of right heart remodeling is crucial for understanding the progression and treatment of FTR. In the scientific literature, there is a lack of comprehensive exploration of right atrial remodeling in patients with FTR, and no reports on the potential correlation between the degree of this remodeling and the severity of tricuspid regurgitation (TR) have been published. This study aimed to evaluate the relationship between right heart parameters measured by four-dimensional (4D) automated quantitative echocardiography and the severity of TR in patients with FTR.

Methods: In this prospective case-control study, 100 patients diagnosed with FTR by echocardiography at The First Affiliated Hospital of Guangxi Medical University from February 2022 to March 2023 were prospectively and consecutively selected as the case group, comprising 50 patients with mild FTR and 50 patients with moderate or severe FTR. Additionally, 30 healthy participants served as the control group. Routine echocardiography was employed to obtain two-dimensional (2D) and three-dimensional (3D) images, which was followed by 4D automated quantitative echocardiograph assessment. Analysis of variance (ANOVA) or Kruskal-Wallis tests were used to compare differences between groups, Pearson correlation coefficient analysis was used to discern the relationship between parameters and TR volume, multivariate linear regression was used to identify factors associated with TR volume, and logistic regression was employed to predict the severity of FTR.

Results: The case group consisted of 50 patients with mild FTR (26 males, 52%; age range, 31-78 years; mean age ± SD: 58±11.4 years) and 50 patients with moderate-to-severe FTR (21 males, 42%; age range, 29-87 years; mean age ± SD: 60±13.0 years). Additionally, 30 healthy participants (13 males, 43%; age range, 19-81 years; mean age ± SD: 58±13.3 years) constituted the control group. Patients with moderate-to-severe FTR had significant right heart dilatation and functional decline. The TR volume was highly correlated with right atrium minimum volume (RAVmin; r=0.864; P<0.001), and linear regression showed that the RAVmin was independently correlated with the severity of TR in patients (β=0.820; P<0.001). There were several predictive variables that were significantly associated with increased FTR severity, including right atrial reservoir strain [RASr; odds ratio (OR) =0.702; 95% confidence interval (CI): 0.575-0.857; P=0.001], right atrial conduit strain (RAScd; OR =1.308; 95% CI: 1.098-1.558; P=0.003), and right atrial reservoir circumferential strain (RASr-c; OR =0.823; 95% CI: 0.684-0.990; P=0.04).

Conclusions: 4D automated quantitative echocardiography allows for the dynamic assessment of right heart volume and function. To determine the development of FTR, RA dilation appears to be more significant than right ventricular dilation. The RASr, RAScd, and RASr-c are directly correlated with FTR severity.

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来源期刊
Quantitative Imaging in Medicine and Surgery
Quantitative Imaging in Medicine and Surgery Medicine-Radiology, Nuclear Medicine and Imaging
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4.20
自引率
17.90%
发文量
252
期刊介绍: Information not localized
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