Background:Right ventricular(RV)-arterial uncoupling is a powerful independent predictor of prognosis in heart failure with preserved ejection fraction(HFpEF).Coronary artery disease(CAD)can contribute to the pathophy...Background:Right ventricular(RV)-arterial uncoupling is a powerful independent predictor of prognosis in heart failure with preserved ejection fraction(HFpEF).Coronary artery disease(CAD)can contribute to the pathophysiological characteristics of HFpEF.This study aimed to evaluate the prognostic value of RV-arterial uncoupling in acute HFpEF patients with CAD.Methods:This prospective study included 250 consecutive acute HFpEF patients with CAD.Patients were divided into RV-arterial uncoupling and coupling groups by the optimal cutoff value,based on a receiver operating characteristic curve of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure(TAPSE/PASP).The primary endpoint was a composite of all-cause death,recurrent ischemic events,and HF hospitalizations.Results:TAPSE/PASP≤0.43 provided good accuracy in identifying patients with RV-arterial uncoupling(area under the curve,0.731;sensitivity,61.4%;and specificity,76.6%).Of the 250 patients,150 and 100 patients could be grouped into the RV-arterial coupling(TAPSE/PASP>0.43)and uncoupling(TAPSE/PASP≤0.43)groups,respectively.Revascularization strategies were slightly different between groups;the RV-arterial uncoupling group had a lower rate of complete revascularization(37.0%[37/100]vs.52.7%[79/150],P<0.001)and a higher rate of no revascularization(18.0%[18/100]vs.4.7%[7/150],P<0.001)compared to the RV-arterial coupling group.The cohort with TAPSE/PASP≤0.43 had a significantly worse prognosis than the cohort with TAPSE/PASP>0.43.Multivariate Cox analysis showed TAPSE/PASP≤0.43 as an independent associated factor for the primary endpoint,all-cause death,and recurrent HF hospitalization(hazard ratios[HR]:2.21,95%confidence interval[CI]:1.44-3.39,P<0.001;HR:3.32,95%CI:1.30-8.47,P=0.012;and HR:1.93,95%CI:1.10-3.37,P=0.021,respectively),but not for recurrent ischemic events(HR:1.48,95%CI:0.75-2.90,P=0.257).Conclusion:RV-arterial uncoupling,based on TAPSE/PASP,is independently associated with adverse outcomes in acute HFpEF patients with CAD.展开更多
文摘Background:Right ventricular(RV)-arterial uncoupling is a powerful independent predictor of prognosis in heart failure with preserved ejection fraction(HFpEF).Coronary artery disease(CAD)can contribute to the pathophysiological characteristics of HFpEF.This study aimed to evaluate the prognostic value of RV-arterial uncoupling in acute HFpEF patients with CAD.Methods:This prospective study included 250 consecutive acute HFpEF patients with CAD.Patients were divided into RV-arterial uncoupling and coupling groups by the optimal cutoff value,based on a receiver operating characteristic curve of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure(TAPSE/PASP).The primary endpoint was a composite of all-cause death,recurrent ischemic events,and HF hospitalizations.Results:TAPSE/PASP≤0.43 provided good accuracy in identifying patients with RV-arterial uncoupling(area under the curve,0.731;sensitivity,61.4%;and specificity,76.6%).Of the 250 patients,150 and 100 patients could be grouped into the RV-arterial coupling(TAPSE/PASP>0.43)and uncoupling(TAPSE/PASP≤0.43)groups,respectively.Revascularization strategies were slightly different between groups;the RV-arterial uncoupling group had a lower rate of complete revascularization(37.0%[37/100]vs.52.7%[79/150],P<0.001)and a higher rate of no revascularization(18.0%[18/100]vs.4.7%[7/150],P<0.001)compared to the RV-arterial coupling group.The cohort with TAPSE/PASP≤0.43 had a significantly worse prognosis than the cohort with TAPSE/PASP>0.43.Multivariate Cox analysis showed TAPSE/PASP≤0.43 as an independent associated factor for the primary endpoint,all-cause death,and recurrent HF hospitalization(hazard ratios[HR]:2.21,95%confidence interval[CI]:1.44-3.39,P<0.001;HR:3.32,95%CI:1.30-8.47,P=0.012;and HR:1.93,95%CI:1.10-3.37,P=0.021,respectively),but not for recurrent ischemic events(HR:1.48,95%CI:0.75-2.90,P=0.257).Conclusion:RV-arterial uncoupling,based on TAPSE/PASP,is independently associated with adverse outcomes in acute HFpEF patients with CAD.
文摘目的使用电导导管测量小鼠右心室压力-容积环,评估健康小鼠及肺动脉高压模型小鼠的血流动力学。方法将16只小鼠随机分为实验组(n=8)和对照组(n=8)。实验组小鼠暴露在常压缺氧的环境中10 d,对照组小鼠被安置在室内空气中。使用1.2 F导管从右颈动脉插至升主动脉,另外再穿刺右心室心尖部,用20号针头导入1.2 F压力-容积导管,获得压力-容积的测量值并计算血流动力学参数。比较两组小鼠血流动力学参数的差异。结果两组小鼠体重、右心房重量/体重、左心房重量/体重、(左心室+室间隔)重量/体重比较,差异均无统计学意义(均P>0.05);实验组小鼠右心室重量/(左心室+室间隔)重量[(0.30±0.03)比(0.23±0.06),P=0.0291]、右心室重量/体重[(1.04±0.13)比(0.74±0.10),P=0.0001]显著高于对照组,差异均有统计学意义。两组小鼠心率、主动脉收缩压、主动脉舒张压、右心室舒张末期容积、心室内最大压力上升速度、右心室收缩末期压力-容积关系的斜率、心室内最大压力下降速度、松弛因子τ比较,差异均无统计学意义(均P>0.05)。实验组小鼠血细胞容积率、右心室收缩压、右心室舒张压、搏出功、压力导数的最大值与右心室舒张末期压力容积关系的斜率、前负荷补充搏功、动脉有效弹性显著大于对照组,差异均有统计学意义;而射血时间[(36±2)ms比(45±1)ms,P=0.0001]、心输出量[(5.2±2.6)ml/min比(8.5±2.3)ml/min,P=0.0026]、心室顺应性[(0.43±0.13)μl/mm Hg比(0.68±0.21)μl/mm Hg,P=0.0030(1 mm Hg=0.133 k Pa)]、射血分数[(28±13)%比(51±11)%,P=0.0008]、耦合效率[(0.36±0.15)比(0.73±0.26),P=0.0001]显著低于对照组,差异亦均有统计学意义。结论本研究验证了电导导管测量小鼠右心室压力-容积数据的可能性,为健康状态或疾病状态下的右心室-肺动脉耦合机制的研究提供了方向。
