三尖瓣环收缩期运动幅度评价充血性心力衰竭患者预后的价值

Prognostic value of tricuspid annular plane systolic excusion in patients with congestive heart failure by echocardiography

目的 探讨用三尖瓣环收缩期运动幅度 (TAPSE)评价充血性心力衰竭患者预后的重要价值。方法 研究对象为 48例心功能 (NYHA)Ⅲ～Ⅳ级的充血性心力衰竭 (CHF)患者和 30例正常对照者。常规应用超声心动图测定各组的右室内径 (RVDd)、右房面积 (RAA)、右室面积 (RVA)、右室游离壁厚度 (RVFWT)、右室舒张及收缩末容积 (RVEDV、RVESV)、右室每搏量 (RVSV)及右室射血分数 (RVEF)、TAPSE、二尖瓣舒张早期及晚期血流速度峰值 (E峰、A峰 )、E/A比值及E峰减速时间 (EDT)。选择确定评价CHF预后的可靠指标。结果 与对照组比较 ,CHF组的RVDd、RAA、RVA、RVEDV、RVESV、RVSV、A峰、E峰增大 (P <0 .0 1～ 0 .0 0 1) ;RVFWT、TAPSE、E/A、EDT及RVEF降低 (P <0 .0 1～ 0 .0 0 1) ;TAPSE与RVEF及LVEF呈显著正相关 (r=0 .76及 r=0 .78,P <0 .0 0 1)。随访 (2 0± 11)个月期间 ,有 12例发生心源性猝死 (SCD)。经非变量分析确定RVDd>31mm、TAPSE≤ 14mm、LVEF <35 %和EDT <12 0ms可作为判断心功能NYHAⅢ～Ⅳ级的可靠指标 (P <0 .0 0 1) ,而多变量分析确定TAPSE和LVEF可作为SCD独立的预报因子。结论 TAPSE的测定不受心脏节律的影响 ,在所有CHF患者都容易获得 ,它不仅可反映心功能NYHA分级程度 。

Objective To explore the prognostic value of tricuspid annular plane systolic excusion (TAPSE) in patients with congestive heart failure (CHF) by echocardiography.Methods The study population consisted of 48 consecutive patients with CHF (NYHA class Ⅲ Ⅳ) and 30 normal control (NC) group. All study population underwent a complete echocardiographic evaluation that included systematically measuement of right ventricular end diastolic diameter (RVD d),right atrial area (RAA), right ventricular area (RVA), right ventricular free wall thickness (RVFWT), right ventricular ejection fraction (RVEF), mitral valve peak velocity E, peak velocity A , A/E ratio,peak velocity E deceleration time (EDT) and TAPSE.Results The parameters of cardiac function in CHF group were significant different from those in NC group (P< 0.05 ～ 0.001 ). RVD d,RAA,RVA,RVEDV,RVESV,RVSV,peak velocity E, and peak velocity A were increased (P< 0.01 ～ 0.001 ),but RVFWT,TAPSE,A/E ratio ,EDT and RVEF were decreased (P< 0.01 ～ 0.001 ), a close correlation were found between TAPSE and RVEF or LVEF (r= 0.76 or r= 0.78 ,P< 0.001 ) in patients with CHF. During follow up period (20±11) months,12 patients died with sudden cardiac death(SCD). Univariate analyses showed that RVD d>31 mm、TAPSE≤14 mm、LVEF<35% and EDT<120 ms were significant prognostic information to NYHA class Ⅲ～Ⅳ(P< 0.001 ), Multivariate analysis showed that TAPSE and LVEF were independent predictors of outcome.Conclusions The measurements of TAPSE is easy to obtain in all patients including irrespective of heart rate and rhythm.The TAPSE not only reflects severity of NYHA class ,but also have important value for evalution the prognostic in patients with CHF.