Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
JACC Cardiovasc Imaging. 2015 Mar;8(3):235-245. doi: 10.1016/j.jcmg.2014.12.009. Epub 2015 Feb 11.
The objective of this study was to determine which strain component assessed by 2-dimensional speckle-tracking echocardiography (2DSTE) and 3-dimensional speckle-tracking echocardiography (3DSTE) was the most powerful predictor for future major adverse cardiac events (MACE) in asymptomatic patients with severe aortic stenosis (AS).
Ongoing debate exists regarding the appropriateness of early surgery in asymptomatic severe AS and preserved left ventricular ejection fraction (LVEF). Previous studies showed that 2-dimensional global longitudinal strain (2DGLS) was a significant predictor in asymptomatic severe AS patients. However, the prognostic utility of 3DSTE-derived multidirectional strain parameters has not been investigated in these patients.
We enrolled 104 asymptomatic severe AS patients (indexed aortic valve area <0.6 cm(2)/m(2)) and preserved LVEF and performed strain analysis using both 2DSTE and 3DSTE. Two-dimensional and 3-dimensional global longitudinal, circumferential, and radial strain and global 3-dimensional strain were measured in each patient. All patients were followed to record MACE.
During a median follow-up of 373 days, MACE developed in 33 patients (32%). 2DGLS (-14.7 ± 3.3 vs. -16.3 ± 3.3, p = 0.0168), 3DGLS (-13.5 ± 2.5 vs. -16.1 ± 2.4, p < 0.0001) and 3-dimensional global radial strain (3DGRS) (35.9 ± 4.5 vs. 38.1 ± 4.4, p = 0.0209) were significantly impaired in patients with MACE compared with those without MACE. Kaplan-Meier analysis showed 2DGLS (cutoff: -17.0%), 3DGLS (cutoff: -14.5%), and 3DGRS (cutoff: 39.0%) provide a significant difference in MACE rate. Receiver-operating characteristic analysis revealed that the area under the curve of 3DGLS for MACE (0.78) was significantly larger than that of 2DGLS (0.62, p = 0.0044) and 3DGRS (0.66, p = 0.0069). Separate multivariate analysis revealed 3DGLS was only significant as independent predictor for future MACE after correcting for mean pressure gradient and left ventricular mass index.
3DGLS is the most robust index for predicting future adverse cardiac events in asymptomatic severe AS patients with preserved LVEF.
本研究旨在确定二维斑点追踪超声心动图（2DSTE）和三维斑点追踪超声心动图（3DSTE）评估的应变分量中，哪一个是射血分数保留的重度主动脉瓣狭窄（AS）无症状患者未来发生主要不良心脏事件（MACE）的最强预测因子。
目前对于无症状重度 AS 和射血分数保留的患者是否应早期手术仍存在争议。既往研究表明，二维整体纵向应变（2DGLS）是无症状重度 AS 患者的重要预测因子。然而，这些患者的多维应变参数的 3DSTE 预测价值尚未得到研究。
我们纳入 104 例射血分数保留的无症状重度 AS 患者（主动脉瓣面积指数<0.6 cm²/m²），并使用 2DSTE 和 3DSTE 进行应变分析。对每位患者进行二维和三维整体纵向、环向和径向应变及整体三维应变测量。所有患者均接受随访以记录 MACE。
在中位随访 373 天期间，33 例（32%）患者发生 MACE。与无 MACE 患者相比，MACE 患者的 2DGLS（-14.7±3.3 比-16.3±3.3，p=0.0168）、3DGLS（-13.5±2.5 比-16.1±2.4，p<0.0001）和 3 维整体径向应变（3DGRS）（35.9±4.5 比 38.1±4.4，p=0.0209）显著降低。Kaplan-Meier 分析显示，2DGLS（截断值：-17.0%）、3DGLS（截断值：-14.5%）和 3DGRS（截断值：39.0%）对 MACE 发生率有显著差异。受试者工作特征曲线分析显示，3DGLS 预测 MACE 的曲线下面积（AUC）为 0.78，显著大于 2DGLS（0.62，p=0.0044）和 3DGRS（0.66，p=0.0069）。多变量分析显示，在校正平均压力梯度和左心室质量指数后，3DGLS 是未来发生 MACE 的唯一独立预测因子。
3DGLS 是预测射血分数保留的无症状重度 AS 患者未来不良心脏事件的最有力指标。
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