科研之友
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摘要
Over recent decades, several studies have clearly demonstrated the important role of the right ventricle (RV) in the pathophysiology of different cardiac and pulmonary diseases. Heart failure is a severe chronic disease [1,2] and risk stratification of patients is an important step in their management. Right ventricular (RV) systolic function is a key determinant of prognosis in patients with left ventricular systolic dysfunction [3-5]. The RV has a complex geometry, making it hard to analyse its contractility. Since the mid 1990s, several studies have analysed different methods from right heart catheterization to magnetic resonance imaging (MRI) to accurately determine RV ejection fraction (RVEF). However, in 2016, we are still looking for the most practical parameter of RV systolic function. In this issue of the Archives, Venner et al. have retrospectively evaluated the prognostic effect of RV systolic function in 136 patients with idiopathic dilated cardiomyopathy (DCM) [6]. Their mean age was 59.0 +/- 13.2 years and their mean left ventricular ejection fraction was 27.5 +/- 8.7%. The population was treated according to current guidelines: 88% received angiotensin-converting enzyme inhibitors, 90% beta-blockers and 37% mineralocorticoid receptor antagonists. Moreover, 43% of the patients had an internal cardiac defibrillator and 31% had undergone resynchronization therapy. During a mean follow-up of 2.7 years, there were 49 major cardiac events (36% of patients), including 20 cardiac-related deaths. They used the tricuspid annular plane systolic excursion (TAPSE) for the estimation of RV systolic function with a cut-off value of 15.4 mm. They demonstrated in both a multivariable Cox analysis and a propensity score analysis the independent prognostic information derived from TAPSE in patients with DCM (hazard ratio: 2.35, 95% confidence interval 1.27-4.34) [6].
- 出版日期2016-4
