评估舒张期应变率对射血分数保留的心脏淀粉样变性患者生存的预测价值。
Predictive value of assessing diastolic strain rate on survival in cardiac amyloidosis patients with preserved ejection fraction.
作者信息
Liu Dan, Hu Kai, Störk Stefan, Herrmann Sebastian, Kramer Bastian, Cikes Maja, Gaudron Philipp Daniel, Knop Stefan, Ertl Georg, Bijnens Bart, Weidemann Frank
机构信息
Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany.
Department for Cardiovascular Diseases, University Hospital Center Zagreb and School of Medicine, University of Zagreb, Zagreb, Croatia.
出版信息
PLoS One. 2014 Dec 26;9(12):e115910. doi: 10.1371/journal.pone.0115910. eCollection 2014.
OBJECTIVES
Since diastolic abnormalities are typical findings of cardiac amyloidosis (CA), we hypothesized that speckle-tracking-imaging (STI) derived longitudinal early diastolic strain rate (LSRdias) could predict outcome in CA patients with preserved left ventricular ejection fraction (LVEF >50%).
BACKGROUND
Diastolic abnormalities including altered early filling are typical findings and are related to outcome in CA patients. Reduced longitudinal systolic strain (LSsys) assessed by STI predicts increased mortality in CA patients. It remains unknown if LSRdias also related to outcome in these patients.
METHODS
Conventional echocardiography and STI were performed in 41 CA patients with preserved LVEF (25 male; mean age 65±9 years). Global and segmental LSsys and LSRdias were obtained in six LV segments from apical 4-chamber views.
RESULTS
Nineteen (46%) out of 41 CA patients died during a median of 16 months (quartiles 5-35 months) follow-up. Baseline mitral annular plane systolic excursion (MAPSE, 6 ± 2 vs. 8 ± 3 mm), global LSRdias and basal-septal LSRdias were significantly lower in non-survivors than in survivors (all p < 0.05). NYHA class, number of non-cardiac organs involved, MAPSE, mid-septal LSsys, global LSRdias, basal-septal LSRdias and E/LSRdias were the univariable predictors of all-cause death. Multivariable analysis showed that number of non-cardiac organs involved (hazard ratio [HR] = 1.96, 95% confidence interval [CI] 1.17-3.26, P = 0.010), global LSRdias (HR = 7.30, 95% CI 2.08-25.65, P = 0.002), and E/LSRdias (HR = 2.98, 95% CI 1.54-5.79, P = 0.001) remained independently predictive of increased mortality risk. The prognostic performance of global LSRdias was optimal at a cutoff value of 0.85 S-1 (sensitivity 68%, specificity 67%). Global LSRdias < 0.85 S-1 predicted a 4-fold increased mortality in CA patients with preserved LVEF.
CONCLUSIONS
STI-derived early diastolic strain rate is a powerful independent predictor of survival in CA patients with preserved LVEF.
目的
由于舒张功能异常是心脏淀粉样变性（CA）的典型表现，我们推测斑点追踪成像（STI）得出的纵向舒张早期应变率（LSRdias）可预测左心室射血分数保留（LVEF>50%）的CA患者的预后。
背景
包括早期充盈改变在内的舒张功能异常是CA患者的典型表现，且与预后相关。通过STI评估的纵向收缩期应变（LSsys）降低可预测CA患者死亡率增加。目前尚不清楚LSRdias是否也与这些患者的预后相关。
方法
对41例LVEF保留的CA患者（25例男性；平均年龄65±9岁）进行了传统超声心动图和STI检查。从心尖四腔心视图的六个左心室节段获取整体和节段性LSsys和LSRdias。
结果
41例CA患者中有19例（46%）在中位16个月（四分位数间距5-35个月）的随访期间死亡。非存活者的基线二尖瓣环平面收缩期位移（MAPSE，6±2 vs. 8±3 mm）、整体LSRdias和基底间隔LSRdias显著低于存活者（均p<0.05）。纽约心脏协会（NYHA）分级、受累非心脏器官数量、MAPSE、室间隔中部LSsys、整体LSRdias、基底间隔LSRdias和E/LSRdias是全因死亡的单变量预测因素。多变量分析显示，受累非心脏器官数量（风险比[HR]=1.96，95%置信区间[CI]1.17-3.26，P=0.010）、整体LSRdias（HR=7.30，95%CI 2.08-25.65，P=0.002）和E/LSRdias（HR=2.98，95%CI 1.54-5.79，P=0.001）仍然是死亡率增加风险的独立预测因素。整体LSRdias在截断值为0.8 S-1时预后性能最佳（敏感性68%，特异性67%）。整体LSRdias<0.8 S-1预测LVEF保留的CA患者死亡率增加4倍。
结论
STI得出的舒张早期应变率是LVEF保留的CA患者生存的有力独立预测因素。
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