DOI: https://doi.org/10.22263/2312-4156.2021.2.77
Zherko O.M.1, Shkrebneva E.I.2
Scoring scale for assessing the risk of detecting right ventricle diastolic dysfunction of type II in chronic heart failure
1Belarusian Medical Academy of Post-Graduate Education, Minsk, Republic of Belarus
2Minsk Scientific-Practical Center of Surgery, Transplantation and Hematology, Minsk, Republic of Belarus
Vestnik VGMU. 2021;20(2):77-87.
Abstract.
Odjectives. To develop a scoring scale for assessing the risk of detecting right ventricle (RV) diastolic dysfunction (DD) of type II in chronic heart failure (CHF).
Material and methods. In 2017-2018, a clinical and instrumental examination of 247 patients aged 40-86 years was performed on the basis of Health Care Institution «The 1st City Clinical Hospital» in Minsk, in 2019-2020, 129 patients at the age of 39-84 years were examined in the State Institution «Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology». Study inclusion criteria: sinus rhythm, essential arterial hypertension (AH), chronic ischemic heart disease (IHD), CHF, informed voluntary consent of the patient to participate in the study. Exclusion criteria: primary mitral regurgitation, mitral stenosis, mitral valve repair or replacement, congenital heart defects, acute and chronic diseases of the lungs and kidneys.
Results. The sum of points>52 obtained using a scoring scale that includes scientifically based ultrasound criteria for global cardiac remodelling: RV early diastolic filling index E/eʹ >4.08 (sensitivity (S) 81.1%, specificity (Sp) 56.9%) ‒ 15 points, the amplitude of the systolic displacement of the lateral part of the tricuspid annulus in systole to the apex (TAPSE) ≤20 mm (S 74.1%, Sp 83.3%) ‒ 49 points, pulmonary artery systolic pressure ˃32.6 mm Hg (S 85.2%, Sp 79.5%) ‒ 31 points, indicates a high risk of detecting RV DD of type II in CHF (AUC 0.99, S 93.9%, Sp 100.0%). The reproducibility of the results is shown in an independent examination sample of patients with CHF with preserved left ventricular ejection fraction. (AUC 0.99, S 90.0%, Sp 100%, +PV 100.0%, ‒ PV 34.5% with a cut-off threshold >52).
Conclusions.When using the scale, the score is >52, it is recommended to perform a comprehensive targeted assessment of global cardiac remodelling to determine RV DD of type II in a patient with CHF, complicating essential AH, chronic IHD.
Key words: right ventricular diastolic dysfunction of type II, chronic heart failure, echocardiography, scoring scale.
References
1. Gorter TM, van Veldhuisen DJ, Bauersachs J, Borlaug BA, Celutkiene J, Coats AJS, et al. Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2018 Jan;20(1):16-37. doi: http://dx.doi.org/10.1002/ejhf.1029
2. Zherko OM. Ultrasound markers of structural and functional heart remodeling in chronic heart failure. Lecheb Delo. 2020;(1):17-22. (In Russ.)
3. Zherko OM. Remodeling of the right heart in chronic heart failure. Lecheb Delo. 2019;(6):12-7. (In Russ.)
4. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography. J Am Soc Echocardiogr. 2010 Jul;23(7):685-713. doi: http://dx.doi.org/10.1016/j.echo.2010.05.010
5. Rosenkranz S, Gibbs JSR, Wachter R, De Marco T, Vonk-Noordegraaf A, Vachiéry J-L. Left ventricular heart failure and pulmonary hypertension dagger. Eur Heart J. 2016 Mar;37(12):942-54. doi: http://dx.doi.org/10.1093/eurheartj/ehv512
6. Galiè N, Humbert M, Vachiery J-L, Gibbs S, Lang I, Torbicki A, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). Eur Heart J. 2016 Jan;37(1):67-119. doi: http://dx.doi.org/10.1093/eurheartj/ehv317
7. Otto CM, ed. Thе practice of clinical echocardiography. 5th ed. Philadelphia, Pennsylvania: Elsevier; 2017. 965 р.
8. Zherko OM. New Comprehensive Approaches to Diagnosis of Right Ventricular Diastolic Dysfunction. Kardiologiia Belarusi. 2020;12(2):207-16. (In Russ.)
9. Zherko OM. N-terminal brain natriuretic peptide precursor in the diagnosis of diastolic and systolic left and right ventricular dysfunction. Lecheb Delo. 2020;(3):28-33. (In Russ.)
10. Zherko OM, Shkrebneva EI. 2D 2D Speckle Tracking Echocardiography in the Prediction of Right Ventricular Diastolic Dysfunction. Kardiologiia Belarusi. 2020;12(5):679-87. (In Russ.)
11. Borlaug BA, Kane GC, Melenovsky V, Olson TP. Abnormal right ventricular–pulmonary artery coupling with exercise in heart failure with preserved ejection fraction. Eur Heart J. 2016 Nov;37(43):3293-3302. doi: http://dx.doi.org/10.1093/eurheartj/ehw241
12. Ostrovskii IuP, Valentiukevich AV, Ilina TV, Koliadko MG, Kurlianskaia EK, Ostrovskii AIu, Shestakova LG, i dr; Ostrovskii IuP, red. Heart failure. Minsk, RB: Belarus navuka; 2016. 503 р. (In Russ.)
13. McDonald MA, Ross HJ. Trying to succeed when the right ventricle fails. Curr Opin Cardiol. 2009 May;24(3):239-45. doi: http://dx.doi.org/10.1097/HCO.0b013e328329e9e8
14. Gorter TM, Hoendermis ES, van Veldhuisen DJ, Voors AA, Lam CSP, Geelhoed B, et al. Right ventricular dysfunction in heart failure with preserved ejection fraction: a systematic review and meta-analysis. Eur J Heart Fail. 2016 Dec;18(12):1472-1487. doi: http://dx.doi.org/10.1002/ejhf.630
15. Damy T, Kallvikbacka-Bennett A, Goode K, Khaleva O, Lewinter C, Hobkirk J, et al. Prevalence of, associations with, and prognostic value of tricuspid annular plane systolic excursion (TAPSE) among out-patients referred for the evaluation of heart failure. J Card Fail. 2012 Mar;18(3):216-25. doi: http://dx.doi.org/10.1016/j.cardfail.2011.12.003
16. Aschauer S, Kammerlander AA, Zotter-Tufaro C, Ristl R, Pfaffenberger S, Bachmann A, et al. The right heart in heart failure with preserved ejection fraction: insights from cardiac magnetic resonance imaging and invasive haemodynamics. Eur J Heart Fail. 2016 Jan;18(1):71-80. doi: http://dx.doi.org/10.1002/ejhf.418
17. Lourenço AP, Leite-Moreira AF, Balligand J-L, Bauersachs J, Dawson D, de Boer R, et al. An integrative translational approach to study heart failure with preserved ejection fraction: a position paper from the Working Group on Myocardial Function of the European Society of Cardiology. Eur J Heart Fail. 2018 Feb;20(2):216-227. doi: http://dx.doi.org/10.1002/ejhf.1059
Information about authors:
Zherko O.M. – Candidate of Medical Sciences, associate professor, head of the Chair of Ultrasound Diagnosis, Belarusian Medical Academy of Post-Graduate Education;
Shkrebneva E.I. – head of the Department of Physiologic Diagnosis, Minsk Scientific-Practical Center of Surgery, Transplantation and Hematology.
Correspondence address: Republic of Belarus, 220013, Minsk, 3-3 P. Brovki str., Belarusian Medical Academy of Post-Graduate Education, Chair of Ultrasound Diagnosis. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Olga М. Zherko.
