三尖瓣瓣环收缩期位移与肺动脉收缩压比值对射血分数减低型心力衰竭患者病程的预测价值

Value of the ratio of tricuspid annulus plane systolic excursion to pulmonary artery systolic pressure in predicting the progression of heart failure with reduced ejection fraction patients

目的:探讨三尖瓣瓣环收缩期位移与肺动脉收缩压比值(TAPSE/PASP)对射血分数减低型心力衰竭(HFrEF)患者病程进展的预测价值。方法:前瞻性选取2022年1-12月在郑州大学第一附属医院确诊HFrEF的患者172例。所有入选者均行常规超声心动图检查,测量常规心脏超声参数、左心房容积指数(LAVi)、右心室面积变化分数(RVFAC),计算二尖瓣口舒张早期速度E峰与二尖瓣瓣环舒张早期平均速度e′比值(E/e′)和TAPSE/PASP。应用超声仪器在线的定量分析软件分别获取左心室整体纵向应变(LVGLS)、左心房储备期应变(LASr)、左心房管道期应变(LAScd)、左心房收缩期应变(LASct)、右心室整体纵向应变(RVGLS)和右心室游离壁应变(RVFWS)。根据TAPSE/PASP中位数将患者分为TAPSE/PASP≥0.50 mm/mmHg组(组1,85例)和TAPSE/PASP<0.50 mm/mmHg组(组2,87例)。记录终点事件。比较两组间上述参数的差异,采用相关性分析方法分析心肌力学参数与TAPSE/PASP的相关性。采用Kaplan-Merier法绘制生存曲线,用Log-rank法比较两组间生存曲线差异。采用单因素和多因素Cox回归模型分析TAPSE/PASP对终点事件的预测价值。结果:两组间年龄、性别、体质指数、合并症和左心室舒张末期容积(LVEDV)差异无统计学意义(均P>0.05)。与组1相比,组2 RVFAC和TAPSE明显减小(均P<0.05),LAVi、左心室收缩末期容积(LVESV)、右心室舒张末期横径(RVDd-base)、E/e′和PASP增大(均P<0.05),LVGLS、LASr、LASct、RVGLS和RVFWS的绝对值明显减小(均P<0.05)。相关性分析显示LVGLS、LASr、RVGLS、RVFAC和6 min步行距离与TAPSE/PASP呈线性相关(r/rs=-0.176、0.181、-0.496、0.472、0.421,均P<0.05)。随访时间(11.71±1.80)个月,组2死亡事件发生率(28.73%)高于组1(10.61%),差异有统计学意义(P<0.05)。多因素Cox回归分析结果显示,TAPAE/PASP是HFrEF患者发生终点事件的独立预测因素之一(校正HR:0.306,95%CI=0.141~0.663,P=0.003)。结论:TAPSE/PASP能够监测HFrEF的病程进展,是其独立预测因素,为临床诊疗提供了新的参考指标。

ObjectiveTo investigate the predictive value of the ratio of tricuspid annulus plane systolic excursion to pulmonary artery systolic pressure(TAPSE/PASP)in the progression of heart failure with reduced ejection fraction(HFrEF)patients.MethodsA total of 172 patients with HFrEF in the First Affiliated Hospital of Zhengzhou University from January to December 2022 were prospectively selected.All participants underwent routine echocardiography,the routine cardiac ultrasound parameters,left atrial volume index(LAVi),right ventricular fractional area change(RVFAC)were measured.The ratio of early diastolic velocity E peak of the mitral valve orifice to the early diastolic mean velocity e′of the mitral valve annulus(E/e′)and TAPSE/PASP were calculated.The online quantitative analysis software of the ultrasound instrument were used to obtain the left ventricular global longitudinal strain(LVGLS),left atrial reservior strain(LASr),left atrial conduit strain(LAScd),left atrial contraction strain(LASct),right ventricular global systolic strain(RVGLS),and right ventricular free wall strain(RVFWS).According to the median of TAPSE/PASP,the patients were divided into TAPSE/PASP≥0.50 mm/mmHg group(group 1,85 cases)and TAPSE/PASP<0.50 mm/mmHg group(group 2,87 cases).The endpoint events were recorded.The differences of the above parameters in two groups were compared,the correlation analysis was used to analyze the correlations between myocardial mechanical parameters and TAPSE/PASP.The Kaplan-Merier method was used to draw survival curves,and the Log-rank method was used to compare the differences in survival curves in the two groups.The univariate and multivariate Cox regression models were used to analyze the predictive value of TAPSE/PASP for end-point events.ResultsThere were no significant differences in age,gender,body mass index,complications and left ventricular end-diastolic volume(LVEDV)between the two groups(all P>0.05).Compared with group 1,patients in group 2 showed a significant decrease in RVFAC and TAPSE(all P<0.05),while the LAVi,left ventricular end-systolic volume(LVESV),right ventricular end-diastolic diameter(RVDd-base),E/e′and PASP were increased(all P<0.05),the absolute values of LVGLS,LASr,LASct,RVGLS,and RVFWS were significantly decreased(all P<0.05).Correlation analysis showed that LVGLS,LASr,RVGLS,RVFAC and 6-min walking distance were linearly correlated with TAPSE/PASP(r/r s=-0.176,0.181,-0.496,0.472,0.421;all P<0.05).The follow-up time was(11.71±1.80)months,and the incidence of death events in group 2(28.73%)was higher than that in group 1(10.61%),with a significant difference(P<0.05).The results of multivariate Cox regression analysis showed that TAPAE/PASP was one of the independent predictive factors for endpoint events in HFrEF patients,with adjusted HR:0.306,95%CI=0.141-0.663,P=0.003.ConclusionsTAPSE/PASP can monitor the progression of chronic heart failure and is one of the independent predictive factors,providing a new reference indicator for clinical diagnosis and treatment.