Nicola Benjamin, Veronika Schiffer, Carolin Resag, Panagiota Xanthouli, Moritz Braun, Satenik Harutyunova, Christina A Eichstaedt, Benjamin Egenlauf, Alberto M Marra, Eduardo Bossone, Antonio Cittadini, David G Kiely, Ekkehard Grünig
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The objective of this study was to investigate sex differences in echocardiographic European Society of Cardiology (ESC)/European Respiratory Society (ERS) risk stratification parameters and their impact on survival estimation in patients with pulmonary arterial hypertension (PAH).</p><p><strong>Methods: </strong>In this retrospective, cross-sectional study with a mean follow-up time of 3.2 ± 2.65 years (median, 2.78 years), clinical parameters including right atrial (RA) area, right ventricular area, and tricuspid annular plane systolic excursion (TAPSE) divided by systolic pulmonary artery pressure (sPAP) were assessed. Thresholds of ESC/ERS risk stratification were compared using multivariable Cox regression analysis.</p><p><strong>Results: </strong>Of 748 patients with PAH (mean age, 65 ± 15 years; 63% women), men had significantly larger right heart size than women (RA area 21.76 ± 7.64 vs 17.65 ± 6.82 cm<sup>2</sup>, P < .001; right ventricular area 24.02 ± 7.15 cm<sup>2</sup> vs 18.41 ± 5.75 cm<sup>2</sup>, P < .001). This difference was consistent throughout all World Health Organization functional classes and cardiac index risk groups, except for the RA area in the cardiac index high-risk group and World Health Organization functional class IV. On multivariable analysis, indexed values showed more pronounced differences for age-adjusted survival analysis compared with ESC/ERS risk stratification thresholds. TAPSE/sPAP showed no significant sex differences, which makes this parameter a robust prognostic predictor.</p><p><strong>Conclusions: </strong>This is the first study focusing on sex differences in right heart size obtained by echocardiography in patients with PAH. For risk stratification indexing RA area to body surface area could be more reflective of body composition. 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Thresholds of ESC/ERS risk stratification were compared using multivariable Cox regression analysis.</p><p><strong>Results: </strong>Of 748 patients with PAH (mean age, 65 ± 15 years; 63% women), men had significantly larger right heart size than women (RA area 21.76 ± 7.64 vs 17.65 ± 6.82 cm<sup>2</sup>, P < .001; right ventricular area 24.02 ± 7.15 cm<sup>2</sup> vs 18.41 ± 5.75 cm<sup>2</sup>, P < .001). This difference was consistent throughout all World Health Organization functional classes and cardiac index risk groups, except for the RA area in the cardiac index high-risk group and World Health Organization functional class IV. On multivariable analysis, indexed values showed more pronounced differences for age-adjusted survival analysis compared with ESC/ERS risk stratification thresholds. 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引用次数: 0
摘要
背景：在健康受试者中，各种超声心动图参数已经检测到右心功能的性别差异。研究问题：本研究的目的是探讨肺动脉高压（PAH）患者超声心动图ESC/ERS风险分层参数的性别差异及其对生存估计的影响。研究设计和方法：在这项回顾性横断面研究中，平均随访时间为3.2±2.65（中位2.78）年，评估临床参数，包括右心房（RA）、右心室（RV）面积和三尖瓣环平面收缩偏移（TAPSE），并以收缩期肺动脉压（sPAP）划分。采用多变量Cox回归分析比较ESC/ERS风险分层阈值。结果：748例PAH患者（平均年龄65±15岁，63%为女性），男性右心尺寸明显大于女性（RA面积21.76±7.64 cm2 vs. 17.65±6.82 cm2, p2 vs. 18.41±5.75 cm2）。结论：本研究首次关注超声心动图在PAH患者右心尺寸的性别差异。对于风险分层，ra面积与体表面积的指标化更能考虑到身体成分。相比之下，TAPSE/sPAP值与性别无关，是PAH的一个可靠的预后因素。
Sex-Specific Differences in Echocardiographic Parameters of Risk Stratification in Pulmonary Arterial Hypertension.
Background: In healthy subjects, sex differences in right heart function have been detected for various echocardiographic parameters. The objective of this study was to investigate sex differences in echocardiographic European Society of Cardiology (ESC)/European Respiratory Society (ERS) risk stratification parameters and their impact on survival estimation in patients with pulmonary arterial hypertension (PAH).
Methods: In this retrospective, cross-sectional study with a mean follow-up time of 3.2 ± 2.65 years (median, 2.78 years), clinical parameters including right atrial (RA) area, right ventricular area, and tricuspid annular plane systolic excursion (TAPSE) divided by systolic pulmonary artery pressure (sPAP) were assessed. Thresholds of ESC/ERS risk stratification were compared using multivariable Cox regression analysis.
Results: Of 748 patients with PAH (mean age, 65 ± 15 years; 63% women), men had significantly larger right heart size than women (RA area 21.76 ± 7.64 vs 17.65 ± 6.82 cm2, P < .001; right ventricular area 24.02 ± 7.15 cm2 vs 18.41 ± 5.75 cm2, P < .001). This difference was consistent throughout all World Health Organization functional classes and cardiac index risk groups, except for the RA area in the cardiac index high-risk group and World Health Organization functional class IV. On multivariable analysis, indexed values showed more pronounced differences for age-adjusted survival analysis compared with ESC/ERS risk stratification thresholds. TAPSE/sPAP showed no significant sex differences, which makes this parameter a robust prognostic predictor.
Conclusions: This is the first study focusing on sex differences in right heart size obtained by echocardiography in patients with PAH. For risk stratification indexing RA area to body surface area could be more reflective of body composition. In contrast, TAPSE/sPAP values were not sex dependent and were a robust prognostic factor in patients with PAH.
期刊介绍：
The Journal of the American Society of Echocardiography(JASE) brings physicians and sonographers peer-reviewed original investigations and state-of-the-art review articles that cover conventional clinical applications of cardiovascular ultrasound, as well as newer techniques with emerging clinical applications. These include three-dimensional echocardiography, strain and strain rate methods for evaluating cardiac mechanics and interventional applications.
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