罗冬玲,杨丽芳,黄陶然,费洪文,张曹进

• 1:广东省心血管病研究所
• 2:广东省人民医院(广东省医学科学院)
• 3:南方医科大学
• 4:心血管辅助诊断科

摘要(Abstract)：

目的 探讨右心房应变面积指数（RASAI），即右心房储备期应变与右心房面积比值，与肺动脉高压（PAH）预后的关系。方法 纳入2021年10月至2023年4月期间在广东省人民医院接受治疗的91例PAH患者，测量右心房应变及右心房面积等常规超声参数，分析RASAI与PAH预后的关系。结果 中位随访17(12,26)个月后，共发生19例不良结局。Cox回归分析结果显示，RASAI每升高1个单位，不良结局的发生风险降低40%（无矫正模型，HR0.60,95%CI0.40～0.91,P=0.016）。多变量矫正后，上述关系依然差异有统计学意义（HR 0.50,95%0.29～0.84,P=0.009）。三等分组结果及限制性立方样条法结果进一步证实了上述结果，RASAI与不良预后具有量效递减的关系。通过surv＿cutpoint函数获得RASAI的最佳截断值为0.95。高RASAI(>0.95)组患者的预后显著优于低RASAI（≤0.95）组（多变量矫正模型，HR 0.21,95%CI 0.06～0.70,P=0.011）。结论 RASAI与肺动脉高压的预后密切相关，有望成为疗效评估和预后预测的潜在指标。

关键词(KeyWords)： 右心房应变;右心房面积;肺动脉高压;预后

Abstract:

Keywords:

基金项目(Foundation): 广东省医学科学技术研究基金项目（B2023010）

作者(Author): 罗冬玲,杨丽芳,黄陶然,费洪文,张曹进

参考文献(References)：

• [1]Levine DJ.Pulmonary arterial hypertension:updates in epidemiology and evaluation of patients[J].Am J Manag Care,2021,27(3Suppl):S35-S41.DOI:10.37765/ajmc.2021.88609.
• [2]Humbert M,Kovacs G,Hoeper MM,et al.2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension[J].Eur Respir J,2023,61(1):2200879.DOI:10.1183/13993003.00879-2022.
• [3]Maron BA,Galie N.Diagnosis,treatment,and clinical management of pulmonary arterial hypertension in the contemporary era:a review[J].JAMA Cardiol,2016,1(9):1056-1065.DOI:10.1001/jamacardio.2016.4471.
• [4]Benza RL,Miller DP,Barst RJ,et al.An evaluation of long-term survival from time of diagnosis in pulmonary arterial hypertension from the REVEAL registry[J].Chest,2012,142(2):448-456.DOI:10.1378/chest.11-1460.
• [5]D’ Alonzo GE,Barst RJ,Ayres SM,et al.Survival in patients with primary pulmonary hypertension.Results from a national prospective registry[J].Ann Intern Med,1991,115(5):343-349.DOI:10.7326/0003-4819-115-5-343.
• [6]Jone PN,Schafer M,Li L,et al.Right atrial deformation in predicting outcomes in pediatric pulmonary hypertension[J].Circ Cardiovasc Imaging,2017,10(12):e006250.DOI:10.1161/circimaging.117.006250.
• [7]Blume GG,McLeod CJ,Barnes ME,et al.Left atrial function:physiology,assessment,and clinical implications[J].Eur J Echocardiogr,2011,12(6):421-430.DOI:10.1093/ejechocard/jeq175.
• [8]Piccinino C,Giubertoni A,Zanaboni I,et al.Incremental value of right atrial strain for early diagnosis of hemodynamic deterioration in pulmonary hypertension:a new noninvasive tool for a more comprehensive diagnostic paradigma[J].J Cardiovasc Med(Hagerstown),2017,18(11):866-874.DOI:10.245 9/jcm.0000000000000525.
• [9]Lang IM,Binder T.Right atrial strain is a surrogate of coupling in the right heart[J].Eur Heart J Cardiovasc Imaging,2020,21(8):863-864.DOI:10.1093/ehjci/jeaa104.
• [10]Tello K,Dalmer A,Vanderpool R,et al.Right ventricular function correlates of right atrial strain in pulmonary hypertension:a combined cardiac magnetic resonance and conductance catheter study[J].Am J Physiol Heart Circ Physiol,2020,318(1):H156-H164.DOI:10.1152/ajpheart.00485.2019.
• [11]Gu K,Fernandez F,Kean A,et al.Association between right atrial strain and right ventricular size and function in pulmonary hypertension[J].Heart,Lung and Circulation,2023,32:S224.DOI:10.1016/j.hlc.2023.06.232.
• [12]Bhave NM.Visovatti SH,Kulick B,et al.Right atrial strain is predictive of clinical outcomes and invasive hemodynamic data in group1 pulmonary arterial hypertension[J].Int J Cardiovasc Imaging,2017,33(6):847-855.DOI:10.1007/s10554-017-1081-7.
• [13]Soulat-Dufour L,Addetia K,Miyoshi T,et al.Normal values of right atrial size and function according to age,sex,and ethnicity:results of the World Alliance Societies of Echocardiography study[J].J Am Soc Echocardiogr,2021,34(3):286-300.DOI:10.1016/j.echo.2020.11.004.
• [14]Krittanawong C,Maitra NS,Hassan Virk HU,et al.Normal ranges of right atrial strain:a systematic review and metaanalysis[J].JACC Cardiovasc Imaging,2023,16(3):282-294.DOI:10.1016/j.jcmg.2022.06.022.
• [15]Benza RL,Miller DP,Gomberg-Maitland M,et al.Predicting survival in pulmonary arterial hypertension:insights from the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management(REVEAL)[J].Circulation,2010,122(2):164-172.DOI:10.1161/circulationaha.109.898122.
• [16]Howard LS.Prognostic factors in pulmonary arterial hypertension:assessing the course of the disease[J].Eur Respir Rev,2011,20(122):236-242.DOI:10.1183/09059180.00006711.
• [17]Celant LR,Wessels JN,Kianzad A,et al.Restoration of right ventricular function in the treatment of pulmonary arterial hypertension[J].Heart,2023,109(24):1844-1850.DOI:10.1136/heartjnl-2023-322742.
• [18]Goh ZM,Balasubramanian N,Alabed S,et al.Right ventricular remodelling in pulmonary arterial hypertension predicts treatment response[J].Heart,2022,108(17):1392-1400.DOI:10.113 6/heartjnl-2021-320733.
• [19]Humbert M,Kovacs G,Hoeper MM,et al.2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension[J].Eur Heart J,2022,43(38):3618-3731.DOI:10.1093/eurheartj/ehac237.
• [20]Hasselberg NE,Kagiyama N,Soyama Y,et al.The Prognostic value of right atrial strain imaging in patients with precapillary pulmonary hypertension[J].J Am Soc Echocardiogr,2021,34(8):851-861.e1.DOI:10.1016/j.echo.2021.03.007.
• [21]Hu J,Deng Y,Dai P,et al.Prognostic impact of right atrial strain in systemic lupus erythematosus with pulmonary arterial hypertension[J].Echocardiography,2024,41(9):e15921.DOI:10.1111/echo.15921.
• [22]Tomaselli M,Radu DN,Badano LP,et al.Right atrial remodeling and outcome in patients with secondary tricuspid regurgitation[J].J Am Soc Echocardiogr,2024,37(5):495-505.DOI:10.1016/j.echo.2024.01.003.