三尖瓣环收缩期位移与肺动脉收缩压比值评估肥厚型心肌病合并射血分数保留型心力衰竭患者右心功能

Evaluation of right ventricular function in patients with hypertrophic cardiomyopathy and heart failure with preserved ejection fraction by the ratio of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure

目的探讨用三尖瓣环收缩期位移与肺动脉收缩压比值(TAPSE/PASP)评估肥厚型心肌病(HCM)射血分数保留型心力衰竭(HFpEF)患者右心功能的应用价值。方法纳入2021年1月至2023年1月就诊于郑州大学第一附属医院的HCM合并HFpEF患者74例和健康体检者22例。依据TAPSE/PASP值三分位数将HCM合并HFpEF患者分组(低层组:<0.280 0 mm/mmHg;中层组:0.280 0~0.476 2 mm/mmHg;高层组:>0.476 2 mm/mmHg)。采集常规超声参数并获取磁共振右心室功能参数。比较各组参数的差异, 将TAPSE/PASP与临床参数和右心室功能参数进行相关性分析及多元线性回归分析。结果差异性分析结果显示6 min步行试验、纽约心功能分级(NYHA分级)、心房颤动发生率、左心房面积(LAA)、左心室整体纵向应变(LVGLS)、TAPSE、PASP、右心室面积变化分数(RVFAC)、右心室整体纵向应变(RVGLS)、右心室游离壁纵向应变(RVFWST)、磁共振右心室射血分数(CMR-RVEF)等参数在三组之间差异有统计学意义(均P<0.05);相关性分析及多元线性回归分析结果显示TAPSE/PASP与6 min步行距离、RVFAC、三尖瓣环收缩期峰值速度(RV s′)、CMR-RVEF呈正相关(r=0.449、0.284、0.358、0.577, 均P<0.05);与N末端B型利钠肽前体(NT-proBNP)、NYHA分级、LAA、二尖瓣口舒张早期峰值速度/二尖瓣环舒张早期峰值速度(LV E/e′)、LVGLS、RVGLS、RVFWST、三尖瓣口舒张早期峰值速度/三尖瓣环舒张早期峰值速度(RV E/e′)呈负相关(r/rs=-0.336、-0.349、-0.468、-0.452、-0.444、-0.339、-0.405、-0.320, 均P<0.05);LAA、CMR-RVEF与TAPSE/PASP存在独立相关性(均P<0.05)。结论 TAPSE/PASP可对HCM合并HFpEF患者的右心功能进行早期、简单快速、便捷有效的评估, 从而指导临床治疗和监测病情发展。

Objective To evaluate the value of the ratio of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure(TAPSE/PASP)in evaluating right ventricular function of patients with hypertrophic cardiomyopathy(HCM)and heart failure with preserved ejection fraction(HFpEF).Methods A total of 74 patients with HCM and HFpEF and 22 healthy individuals who visited the First Affiliated Hospital of Zhengzhou University from January 2021 to January 2023 were included in this study.The HCM patients with HFpEF were divided into three groups based on the tertiles of the TAPSE/PASP(low group:<0.2800 mm/mmHg;middle group:0.2800-0.4762 mm/mmHg;high group:>0.4762 mm/mmHg).Conventional echocardiographic parameters were collected,and two-dimensional speckle tracking technology was used to obtain right ventricular strain parameters.The differences in parameters among the groups were compared,and the correlations between TAPSE/PASP and clinical parameters and right ventricular function parameters were analyzed.Results The results of difference analysis showed that there were significant differences in 6-minute walking test,New York Heart Association grade(NYHA grade),incidence of atrial fibrillation,left atrial area(LAA),left ventricular global longitudinal strain(LVGLS),TAPSE,PASP,right ventricular fractional area change(RVFAC),right ventricular global longitudinal strain(RVGLS),right ventricular free wall strain(RVFWST)and cardiac magnetic resonance right ventricular ejection fraction(CMR-RVEF)among the three groups.The results of correlation analysis and multiple linear regression analysis showed that the TAPSE/PASP was positively correlated with 6-minute walking distance,RVFAC,tricuspid annulus peak systolic velocity(RV s′),and CMR-RVEF(r=0.449,0.284,0.358,0.577;all P<0.05).It was negatively correlated with N-terminal pro-brain natriuretic peptide(NT-proBNP),NYHA grade,LAA,mitral early diastolic peak velocity/mitral annulus early diastolic peak velocity(LV E/e′),LVGLS,RVGLS,RVFWST and tricuspid early diastolic peak velocity/tricuspid annulus early diastolic peak velocity(RV E/e′)(r/rs=-0.336,-0.349,-0.468,-0.452,-0.444,-0.339,-0.405,-0.320;all P<0.05).The LAA and CMR-RVEF correlated independently with TAPSE/PASP(all P<0.05).Conclusions The TAPSE/PASP can provide an early,simple,rapid,and convenient evaluation of right ventricular function in patients with HCM and HFpEF,so as to guide clinical treatment and monitoring disease progression.