APHP, Cardiovascular Department and INSERM U955 Team 3, Henri Mondor University Hospital, 51 Av de Lattre de Tassigny, 94100 Creteil, France.
Eur Heart J Cardiovasc Imaging. 2013 Jan;14(1):77-84. doi: 10.1093/ehjci/jes156. Epub 2012 Aug 14.
Global longitudinal strain (GLS) seems accurate for detecting subclinical myocardial dysfunction, and may therefore be used to improve risk stratification for cardiac surgery.
Longitudinal strain (by two-dimensional speckle tracking) was computed in 425 patients [mean age 67 ± 13 years, 69% male, left ventricular ejection fraction (LVEF) 51 ± 13%] referred for cardiac surgery [isolated coronary artery bypass graft (CABG) (n = 155), aortic valve surgery (n = 174), mitral surgery (n = 96)]. GLS (global-ε) was assessed for predicting early postoperative death. Despite a fair correlation between LVEF and global strain (r = -0.73, P < 0.0001), 40% of patients with preserved LVEF (defined as LVEF ≥50%) had abnormal global-ε (defined as global-ε >-16%): -12.8 ± 1.7%, range -15% to -8%. In patients with preserved LVEF, NT-proBNP level (983 vs. 541 pg/mL, P = 0.03), heart failure symptoms (NYHA class, 2.2 ± 0.9 vs. 1.9 ± 0.9, P = 0.02), and the need for prolonged (>48 h) inotropic support after surgery (33.3 vs. 21.2%, P = 0.03) were greater when global-ε was impaired. Importantly, despite similar EuroSCORE (9.7 ± 12 vs. 7.7 ± 9%, P = 0.2 for EuroSCORE I and 4.2 ± 6.2 vs. 3.4 ± 4.9%, P = 0.4 for EuroSCORE II), the rate of postoperative death was 2.4-fold (11.8 vs. 4.9%, P = 0.04) in patients with preserved LVEF when global-ε was impaired. Multivariate analysis showed that global-ε is an independent predictor for early postoperative mortality [odds ratio = 1.10 (1.01-1.21)] after adjustment to EuroSCORE.
GLS has an incremental value over LVEF for risk stratification in patients referred for cardiac surgery.
整体纵向应变（GLS）似乎能够准确检测出亚临床心肌功能障碍，因此可用于改善心脏手术的风险分层。
对 425 名接受心脏手术的患者（平均年龄 67 ± 13 岁，69%为男性，左心室射血分数[LVEF]为 51 ± 13%）进行了纵向应变（通过二维斑点追踪）计算[孤立的冠状动脉旁路移植术（CABG）（n = 155）、主动脉瓣手术（n = 174）、二尖瓣手术（n = 96）]。GLS（整体-ε）用于预测术后早期死亡。尽管 LVEF 与整体应变之间存在良好的相关性（r = -0.73，P < 0.0001），但仍有 40%的保留 LVEF 的患者（定义为 LVEF ≥50%）出现异常的整体-ε（定义为整体-ε >-16%）：-12.8 ± 1.7%，范围为-15%至-8%。在保留 LVEF 的患者中，NT-proBNP 水平（983 与 541 pg/mL，P = 0.03）、心力衰竭症状（NYHA 分级，2.2 ± 0.9 与 1.9 ± 0.9，P = 0.02）和术后需要长时间（>48 h）正性肌力支持（33.3%与 21.2%，P = 0.03）的患者中，整体-ε 受损的患者更大。重要的是，尽管 EuroSCORE 相似（9.7 ± 12 与 7.7 ± 9%，P = 0.2 用于 EuroSCORE I，4.2 ± 6.2 与 3.4 ± 4.9%，P = 0.4 用于 EuroSCORE II），但在保留 LVEF 的患者中，整体-ε 受损时，术后死亡率是正常患者的 2.4 倍（11.8%与 4.9%，P = 0.04）。多变量分析表明，在调整了 EuroSCORE 后，整体-ε 是术后早期死亡率的独立预测因子[比值比= 1.10（1.01-1.21）]。
GLS 对于接受心脏手术的患者的风险分层具有比 LVEF 更高的增量价值。
