摘要
目的初步探讨二维斑点追踪超声心动图(2D-STE)评估右心房及右心室心肌应变与左心室辅助装置(LVAD)植入后患者早期死亡的相关性。方法前瞻性纳入2022年4月至2024年3月在西安交通大学第一附属医院进行LVAD植入的39例终末期心力衰竭患者。获取所有患者在LVAD植入前3 d内的常规经胸超声心动图(TTE)图像,详细评估左心室功能和右心室功能。采用2D-STE技术获得右心室游离壁纵向应变(RVFWSL)、右心室四腔心纵向应变(RV4CSL)、右心房储存期应变(RASr)、管道期应变(RAScd)和收缩期应变(RASct)。以患者术后早期死亡为终点事件。根据患者LVAD植入后3个月内是否发生死亡分为存活组和死亡组。结果在所有患者中,5例患者LVAD植入术后发生院内死亡,其中4例患者死因为右心衰竭,1例患者死因为恶性心律失常。死亡组RVFWSL、RV4CSL(绝对值)显著低于存活组,差异有统计学意义(均P<0.05)。多因素Cox回归分析结果显示,RVFWSL、RV4CSL是患者3个月内死亡的风险因素[HR为0.521(95%CI=0.275~0.986),P=0.045;HR为0.491(95%CI=0.252~0.958),P=0.037]。ROC曲线分析结果显示RVFWSL预测3个月内死亡的诊断界值为≤|-12.1|%,曲线下面积(AUC)为0.938(0.812~0.990);RV4CSL预测3个月内死亡的诊断界值为≤|-14.2|%,AUC为0.926(0.796~0.985)。结论终末期心力衰竭患者右心室应变RVFWSL≤|-12.1|%、RV4CSL≤|-14.2|%时,患者植入LVAD后3个月内死亡的风险增加。
ObjectiveTo preliminarily investigate the correlation between right atrial and right ventricular myocardial strain,assessed by two-dimensional speckle-tracking echocardiography(2D-STE),and early death in patients after left ventricular assist device(LVAD)implantation.MethodsA total of 39 patients with end-stage heart failure who underwent LVAD implantation were prospectively included in the First Affiliated Hospital of Xi′an Jiaotong University from April 2022 to March 2024.Routine transthoracic echocardiography(TTE)images were obtained within 3 days before LVAD implantation for all patients to comprehensively assess left ventricular and right ventricular function.The right ventricular free wall longitudinal strain(RVFWSL),right ventricular four-chamber longitudinal strain(RV4CSL),right atrial reservoir strain(RASr),conduit strain(RAScd),and contraction strain(RASct)were measured by using 2D-STE.The primary endpoint was early postoperative mortality.The patients were divided into survival group and death group based on whether died within 3 months after LVAD implantation.ResultsOf all the patients,five cases died in hospital after LVAD implantation,with 4 deaths attributed to right heart failure and 1 death to malignant arrhythmia.The RVFWSL and RV4CSL(absolute values)in the death group were significantly lower than those in the survival group(both P<0.05).Cox multivariate regression analysis showed that RVFWSL and RV4CSL were risk factors for death within 3 months[HR:0.521(95%CI=0.275-0.986),P=0.045;HR:0.491(95%CI=0.252-0.958),P=0.037].Further ROC curve analysis revealed that the diagnostic cutoff value for RVFWSL in predicting death within 3 months was≤|-12.1|%,with the area under the curve(AUC)of 0.938(0.812-0.990),and the diagnostic cutoff value for RV4CSL was≤|-14.2|%,with an AUC of 0.926(0.796-0.985).ConclusionsIn patients with end-stage heart failure,RVFWSL≤|-12.1|%and RV4CSL≤|-14.2|%are associated with an increased risk of death within 3 months after LVAD implantation.
作者
宋艳
师桃
刘淼淼
邓超
张颖
王飞
武慧蓉
李盼
阮骊韬
Song Yan;Shi Tao;Liu Miaomiao;Deng Chao;Zhang Ying;Wang Fei;Wu Huirong;Li Pan;Ruan Litao(Department of Ultrasound Medicine,the First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,China;Department of Cardiovascular Surgery,the First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,China)
出处
《中华超声影像学杂志》
CSCD
北大核心
2024年第12期1037-1042,共6页
Chinese Journal of Ultrasonography
基金
西安交通大学第一附属医院新医疗新技术(2022J5)。
关键词
超声心动描记术
左心室辅助装置
斑点追踪
应变
死亡
Echocardiography
Left ventricular assist device
Speckle tracking
Strain
Mortality
作者简介
通信作者:阮骊韬,Email:ruanlitao@163.com。
