心脏病学
内科学
医学
心力衰竭
心肌纤维化
阶段(地层学)
纤维化
生物
古生物学
作者
Fangyan Tian,Li Zhang,Yuji Xie,Yanting Zhang,Shuangshuang Zhu,Chun Ying Wu,Wei Sun,Lianqing Liu,Ying Gao,Bin Wang,Jing Wang,Yali Yang,Qing Lv,Nianguo Dong,Yuman Li,Mingxing Xie
标识
DOI:10.1016/j.jcmg.2021.01.015
摘要
Longitudinal strain of the right ventricular (RV) free wall (RVFWLS) assessed by 2-dimensional (2D) speckle-tracking echocardiography (STE) has been recently demonstrated to correlate with the extent of RV myocardial fibrosis (MF). However, the value of 3-dimensional (3D) STE–derived strain parameters in predicting RV MF has not been investigated in patients with end-stage heart failure (HF). This study aimed to determine which RV strain parameter assessed by 2D-STE and 3D-STE was the most reliable parameter for predicting RV MF in patients with end-stage HF against histological confirmation of MF. A total of 105 consecutive patients with end-stage HF undergoing heart transplantation were enrolled in our study. The conventional RV function parameters, 2D-RVFWLS, and 3D-RVFWLS were obtained in these patients. The degree of MF was quantified by Masson trichrome staining in RV myocardial samples. The study population was divided into 3 groups according to the degree of MF on histology. Patients with severe MF had lower 3D-RVFWLS, 2D-RVFWLS, and conventional parameters of RV function compared with those with mild and moderate MF. RV MF strongly correlated with 3D-RVFWLS ( r = −0.72; p < 0.001), modestly with 2D-RVFWLS ( r = −0.53; p < 0.001), and weakly with conventional RV function parameters ( r = −0.21 to −0.49; p < 0.01). 3D-RVFWLS correlated best with the degree of MF ( r = −0.72 vs. −0.21 to −0.53; p < 0.05) compared with 2D-RVFWLS and conventional RV function parameters. 3D-RVFWLS had the highest accuracy for detecting severe MF (area under the receiver-operating characteristic curve: 0.90 vs. 0.24–0.80; p < 0.05) compared with 2D-RVFWLS and conventional RV parameters. The model with 3D-RVFWLS ( R 2 = 0.63; p < 0.001) was better in predicting the degree of RV MF than that with 2D-RVFWLS ( R 2 = 0.54; p < 0.001). 3D-RVFWLS may be the most robust echocardiographic measure for predicting the extent of RV MF in patients with end-stage HF.
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