Data_Sheet_1_Right Ventricular Dysfunction Predicts Outcome in Acute Heart Failure.docx

AimThe severity of cardiac impairment in acute heart failure (AHF) predicts outcome, but challenges remain to identify prognostically important non-invasive parameters of cardiac function. Left ventricular ejection fraction (LVEF) is relevant, but only in those with reduced LV systolic function. We aimed to assess the standard and advanced parameters of left and right ventricular (RV) function from echocardiography in predicting long-term outcomes in AHF.MethodsA total of 418 consecutive AHF patients presenting over 12 months were prospectively recruited and underwent bedside echocardiography within 24 h of recruitment. We retrospectively assessed 8 RV and 5 LV echo parameters of the cardiac systolic function to predict 2-year mortality, using both guideline-directed and study-specific cutoffs, based on the maximum Youden indices via ROC analysis. For the RV, these were the tricuspid annular plane systolic excursion, RV fractional area change, tissue Doppler imaging (TDI) peak tricuspid annular systolic wave velocity, both peak- and end-systolic RV free wall global longitudinal strain (RV GLS) and strain rate (mean RV GLSR), RV ejection fraction (RVEF) derived from a 2D ellipsoid model and the ratio of the TAPSE to systolic pulmonary artery pressure (SPAP). For the LV, these were the LVEF, mitral regurgitant ΔP/Δt (MR dP/dt), the lateral mitral annular TDI peak systolic wave velocity, LV GLS, and the LV GLSR.ResultsA total of 7/8 parameters of RV systolic function were predictive of 2-year outcome, with study cutoffs like international guidelines. A cutoff of < −1.8 s–1 mean RV GLSR was associated with worse outcome compared to > −1.8 s–1 [HR 2.13 95% CI 1.33–3.40 (p = 0.002)]. TAPSE:SPAP of > 0.027 cm/mmHg (vs. < 0.027 cm/mmHg) predicted worse outcome [HR 2.12 95% CI 1.53–2.92 (p < 0.001)]. A 3-way comparison of 2-year mortality by LVEF from the European Society of Cardiology (ESC) guideline criteria of LVEF > 50, 41–49, and < 40% was not prognostic [38.6% vs. 30.9 vs. 43.9% (p = 0.10)]. Of the 5 parameters of LV systolic function, only an MR dP/dt cutoff of < 570 mmHg was predictive of adverse outcome [HR 1.63 95% CI 1.01–2.62 (p = 0.047)].ConclusionWith cutoffs broadly like the ESC guidelines, we identified RV dysfunction to be associated with adverse prognosis, whereas LVEF could not identify patients at risk.

急性心力衰竭（AHF）中心脏损伤的严重程度可预测预后，但识别具有预后意义的心脏功能无创参数仍存在挑战。左心室射血分数（LVEF）与心脏收缩功能相关，但仅限于左心室收缩功能减退的患者。本研究旨在评估AHF患者从超声心动图获取的左右心室（LV和RV）功能的标准和高级参数，以预测长期预后。方法：共纳入12个月内连续入院的418例AHF患者，在招募后24小时内进行床旁超声心动图检查。我们回顾性评估了8个RV和5个LV的超声心动图参数，以预测2年死亡率，采用指南指导和研究特异性的截止值，基于最大尤登指数通过ROC分析。对于RV，这些参数包括三尖瓣环收缩期位移、RV面积变化率、组织多普勒成像（TDI）峰值三尖瓣环收缩波速度、峰值和末期收缩RV游离壁全局纵向应变（RV GLS）和应变率（平均RV GLSR）、由二维椭球模型得出的RV射血分数（RVEF）以及TAPSE与收缩期肺动脉压力（SPAP）的比率。对于LV，这些参数包括LVEF、二尖瓣反流ΔP/Δt（MR dP/dt）、侧壁二尖瓣环TDI峰值收缩波速度、LV GLS和LV GLSR。结果：8个RV收缩功能参数中有7个可以预测2年预后，与指南截止值一致。平均RV GLSR < −1.8 s−1的截止值与预后较差相关，与> −1.8 s−1相比[HR 2.13 95% CI 1.33–3.40 (p = 0.002)]。TAPSE:SPAP > 0.027 cm/mmHg（与< 0.027 cm/mmHg相比）预测预后较差[HR 2.12 95% CI 1.53–2.92 (p < 0.001)]。根据欧洲心脏病学会（ESC）LVEF > 50%、41–49%和< 40%的指南标准对2年死亡率进行的3组比较，LVEF不具备预后价值[38.6% vs. 30.9 vs. 43.9% (p = 0.10)]。在5个LV收缩功能参数中，只有MR dP/dt < 570 mmHg的截止值可以预测不良预后[HR 1.63 95% CI 1.01–2.62 (p = 0.047)]。结论：采用类似于ESC指南的截止值，我们确定了RV功能障碍与不良预后相关，而LVEF不能识别处于风险的患者。