Significant Disagreement Between Conventional Parameters and 3D Echocardiography-Derived Ejection Fraction in the Detection of Right Ventricular Systolic Dysfunction and Its Association With Outcomes.

Autor:	Tolvaj M; Heart and Vascular Center, Semmelweis University, Budapest, Hungary., Kovács A; Heart and Vascular Center, Semmelweis University, Budapest, Hungary; Department of Experimental Cardiology and Surgical Techniques, Semmelweis University, Budapest, Hungary. Electronic address: attila.kovacs@med.semmelweis-univ.hu., Radu N; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Carol Davila University of Medicine and Pharmacy, Prof. Dr. C. C. Iliescu Institute, Bucharest, Romania., Cascella A; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy., Muraru D; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy., Lakatos B; Heart and Vascular Center, Semmelweis University, Budapest, Hungary., Fábián A; Heart and Vascular Center, Semmelweis University, Budapest, Hungary., Tokodi M; Heart and Vascular Center, Semmelweis University, Budapest, Hungary., Tomaselli M; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy., Gavazzoni M; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy., Perelli F; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy., Merkely B; Heart and Vascular Center, Semmelweis University, Budapest, Hungary., Badano LP; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy., Surkova E; Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
Jazyk:	angličtina
Zdroj:	Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography [J Am Soc Echocardiogr] 2024 Jul; Vol. 37 (7), pp. 677-686. Date of Electronic Publication: 2024 Apr 17.
DOI:	10.1016/j.echo.2024.04.005
Abstrakt:	Aims: Conventional echocardiographic parameters such as tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and free-wall longitudinal strain (FWLS) offer limited insights into the complexity of right ventricular (RV) systolic function, while 3D echocardiography-derived RV ejection fraction (RVEF) enables a comprehensive assessment. We investigated the discordance between TAPSE, FAC, FWLS, and RVEF in RV systolic function grading and associated outcomes. Methods: We analyzed two- and three-dimensional echocardiography data from 2 centers including 750 patients followed up for all-cause mortality. Right ventricular dysfunction was defined as RVEF <45%, with guideline-recommended thresholds (TAPSE <17 mm, FAC <35%, FWLS >-20%) considered. Results: Among patients with normal RVEF, significant proportions exhibited impaired TAPSE (21%), FAC (33%), or FWLS (8%). Conversely, numerous patients with reduced RVEF had normal TAPSE (46%), FAC (26%), or FWLS (41%). Using receiver-operating characteristic analysis, FWLS exhibited the highest area under the curve of discrimination for RV dysfunction (RVEF <45%) with 59% sensitivity and 92% specificity. Over a median 3.7-year follow-up, 15% of patients died. Univariable Cox regression identified TAPSE, FAC, FWLS, and RVEF as significant mortality predictors. Combining impaired conventional parameters showed that outcomes are the worst if at least 2 parameters are impaired and gradually better if only one or none of them are impaired (log-rank P < .005). Conclusion: Guideline-recommended cutoff values of conventional echocardiographic parameters of RV systolic function are only modestly associated with RVEF-based assessment. Impaired values of FWLS showed the closest association with the RVEF cutoff. Our results emphasize a multiparametric approach in the assessment of RV function, especially if 3D echocardiography is not available. Competing Interests: Conflicts of Interest B.L., A.F., and A.K. report personal fees from Argus Cognitive, outside the submitted work. E.S. is an employee and shareholder of AstraZeneca and reports speaker honoraria from GE Healthcare and 123sonography, outside of the submitted work. All other authors report no competing interests that are directly or indirectly related to the work submitted for publication. (Copyright © 2024 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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