心肌环向应变对无症状个体新发心力衰竭和心血管事件的预后价值：动脉粥样硬化多民族研究。
Prognostic value of myocardial circumferential strain for incident heart failure and cardiovascular events in asymptomatic individuals: the Multi-Ethnic Study of Atherosclerosis.
机构信息
Johns Hopkins University, Baltimore, MD, USA.
出版信息
Eur Heart J. 2013 Aug;34(30):2354-61. doi: 10.1093/eurheartj/eht133. Epub 2013 May 3.
AIMS
Left ventricular (LV) circumferential strain (Ecc) is a sensitive index of regional myocardial function. Currently, no studies have assessed its prognostic value in general population. We sought to investigate whether Ecc has a prognostic value for predicting incident heart failure (HF) and other major cardiovascular events in asymptomatic individuals without a history of previous cardiovascular diseases.
METHODS AND RESULTS
We, prospectively, assessed incident HF and atherosclerotic events during a 5.5 ± 1.3-year period in 1768 asymptomatic individuals aged 45-84 (mean age 65 years; 47% female) who underwent tagged magnetic resonance imaging for strain determination. During the follow-up period, 39 (2.2%) participants experienced incident HF and 108 (6.1%) participants had atherosclerotic cardiovascular events. Average of peak Ecc of 12-LV segments (Ecc-global) and mid-slice (Ecc-mid) was -17.0 ± 2.4 and -17.5 ± 2.7%, respectively. Participants with average absolute Ecc-mid lower than -16.9% had a higher cumulative hazard of incident HF (log-rank test, P = 0.001). In cox regression analysis, Ecc-mid predicted incident HF independent of age, diabetes status, hypertension, interim myocardial infarction, LV mass index, and LV ejection fraction (hazard ratio 1.15 per 1%, 95% CI: 1.01-1.31, P = 0.03). This relationship remained significant after adjustment for LV-end-systolic wall stress into covariates. In addition, by adding Ecc-mid to risk factors, LV ejection fraction, and the LV mass index, both the global χ(2) value (76.6 vs. 82.4, P = 0.04) and category-less net-reclassification index (P = 0.01, SE = 0.18, z = 2.53) were augmented for predicting HF. Circumferential strain was also significantly related to the composite atherosclerotic cardiovascular events, but its relationship was attenuated after introducing the LV mass index.
CONCLUSION
Circumferential shortening provides robust, independent, and incremental predictive value for incident HF in asymptomatic subjects without any history of previous clinical cardiovascular disease.
CLINICAL TRIAL REGISTRATION
http://www.clinicaltrials.gov. Unique identifier: NCT00005487.
目的
左心室（LV）环向应变（Ecc）是局部心肌功能的敏感指标。目前，尚无研究评估其在普通人群中的预后价值。我们旨在探讨 Ecc 对预测无症状人群中无既往心血管疾病史的心力衰竭（HF）和其他主要心血管事件的发生是否具有预后价值。
方法和结果
我们前瞻性地评估了 1768 名年龄在 45-84 岁（平均年龄 65 岁；47%为女性）、无既往心血管疾病史的无症状个体在 5.5±1.3 年期间发生 HF 和动脉粥样硬化性事件的情况。这些个体接受了标记磁共振成像以确定应变。在随访期间，39 名（2.2%）参与者发生了 HF 事件，108 名（6.1%）参与者发生了动脉粥样硬化性心血管事件。12 个 LV 节段的峰值 Ecc 平均值（Ecc-global）和中段 Ecc（Ecc-mid）分别为-17.0±2.4%和-17.5±2.7%。Ecc-mid 绝对值低于-16.9%的参与者发生 HF 的累积风险更高（对数秩检验，P=0.001）。在 Cox 回归分析中，Ecc-mid 独立于年龄、糖尿病状态、高血压、中期心肌梗死、LV 质量指数和 LV 射血分数预测 HF 事件（风险比为每 1%增加 1.15，95%CI：1.01-1.31，P=0.03）。在调整了 LV 收缩末期壁应力后，这种关系仍然显著。此外，通过将 Ecc-mid 添加到危险因素、LV 射血分数和 LV 质量指数中，HF 的预测全球 χ(2)值（76.6 与 82.4，P=0.04）和无类别净重新分类指数（P=0.01，SE=0.18，z=2.53）均有所增加。环向应变与复合动脉粥样硬化性心血管事件也显著相关，但在引入 LV 质量指数后，这种关系减弱。
结论
在无既往临床心血管疾病史的无症状个体中，环向缩短对 HF 的发生具有稳健、独立和增量的预测价值。
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