Rangel Inês, Gonçalves Alexandra, de Sousa Carla, Almeida Pedro Bernardo, Rodrigues João, Macedo Filipe, Silva Cardoso José, Maciel Ma Júlia
Cardiology Department, Centro Hospitalar de S. João, Porto, Portugal; Faculty of Medicine of Porto University, Porto, Portugal.
Faculty of Medicine of Porto University, Porto, Portugal.
Rev Port Cardiol. 2014 Jul-Aug;33(7-8):403-9. doi: 10.1016/j.repc.2014.01.023. Epub 2014 Aug 23.
The prognostic value of myocardium deformation measurements in chronic heart failure (CHF) is still poorly addressed. The purpose of this study was to evaluate the correlation of left ventricular (LV) global longitudinal strain (GLS) with clinical and prognostic indicators in patients with CHF and systolic dysfunction.
Ambulatory patients with CHF and LV ejection fraction (LVEF) <45% were studied by two-dimensional and Doppler transthoracic echocardiogram with assessment of GLS. An indication of prognostic status was obtained by the Seattle Heart Failure Model (SHFM) prognostic estimates for life expectancy.
We included 54 CHF patients (mean age 55±12 years; 80% male). GLS was significantly correlated with NYHA functional class (r=0.41, p=0.002), BNP levels (r=0.47, p=0.001), LVEF (r=-0.69, p<0.001) and LV end-diastolic pressure, assessed by E/e' ratio (r=0.35, p<0.014) and left atrial maximal volume index (r=0.57, p<0.001). A significant correlation was found between GLS and SHFM prognostic estimates for life expectancy (r=-0.41, p=0.002). The multivariate logistic regression analysis showed that GLS independently predicted an estimated life expectancy <10 years (OR 2.614 [95% CI 1.010-6.763]). The corresponding area under the ROC curve was 0.802 (0.653-0.951) and the best obtained threshold was -9.5 (80% sensitivity, 65% specificity, p=0.003).
GLS was strongly associated with a higher disease severity status and predicted a lower prognostic estimate for life expectancy.
心肌形变测量在慢性心力衰竭（CHF）中的预后价值仍未得到充分研究。本研究旨在评估左心室（LV）整体纵向应变（GLS）与CHF合并收缩功能障碍患者的临床及预后指标之间的相关性。
对门诊CHF患者且左心室射血分数（LVEF）<45%者进行二维及多普勒经胸超声心动图检查，评估GLS。通过西雅图心力衰竭模型（SHFM）对预期寿命的预后估计来获取预后状态指标。
我们纳入了54例CHF患者（平均年龄55±12岁；80%为男性）。GLS与纽约心脏协会（NYHA）功能分级显著相关（r=0.41，p=0.002）、脑钠肽（BNP）水平（r=0.47，p=0.001）、LVEF（r=-0.69，p<0.001）以及通过E/e'比值评估所得的左心室舒张末期压力（r=0.35，p<0.014）和左心房最大容积指数（r=0.57，p<0.001）。GLS与SHFM对预期寿命的预后估计之间存在显著相关性（r=-0.41，p=0.002）。多因素逻辑回归分析表明，GLS可独立预测预期寿命<10年（比值比2.614 [95%置信区间1.010 - 6.763]）。相应的ROC曲线下面积为0.802（0.653 - 0.951），最佳阈值为-9.5（灵敏度80%，特异度65%，p=0.003）。
GLS与更高的疾病严重程度密切相关，并预测较低的预期寿命预后估计。
