Russo Cesare, Jin Zhezhen, Homma Shunichi, Rundek Tatjana, Elkind Mitchell S V, Sacco Ralph L, Di Tullio Marco R
Department of Medicine, Columbia University, New York, NY.
Department of Biostatistics, Columbia University, New York, NY.
Am Heart J. 2015 May;169(5):721-6. doi: 10.1016/j.ahj.2015.02.011. Epub 2015 Feb 21.
Race-ethnic differences exist in the epidemiology of heart failure, with blacks experiencing higher incidence and worse prognosis. Left ventricular (LV) systolic dysfunction (LVSD) detected by speckle-tracking global longitudinal strain (GLS) is a predictor of cardiovascular events including heart failure. It is not known whether race-ethnic differences in GLS-LVSD exist in subjects without overt LV dysfunction.
Participants from a triethnic community-based study underwent 2-dimensional echocardiography with assessment of LV ejection fraction (LVEF) and GLS by speckle-tracking. Participants with LVEF <50% were excluded. Left ventricular systolic dysfunction by GLS was defined as GLS >95% percentile in a healthy sample (-14.7%).
Of the 678 study participants (mean age 71 ± 9 years, 61% women), 114 were blacks; 464, Hispanics; and 100, whites. Global longitudinal strain was significantly lower in blacks (-16.5% ± 3.5%) than in whites (-17.5% ± 3.0%) and Hispanics (-17.3% ± 2.9%) in both univariate (P = .015) and multivariate analyses (P = .011), whereas LVEF was not significantly different between the 3 groups (64.3% ± 4.6%, 63.4% ± 4.9%, 64.7% ± 4.9%, respectively, univariate P = .064, multivariate P = .291). Left ventricular systolic dysfunction by GLS was more frequent in blacks (27.2%) than in whites (19.0%) and Hispanics (14.9%, P = .008). In multivariate analysis adjusted for confounders and cardiovascular risk factors, blacks were significantly more likely to have GLS-LVSD (adjusted odds ratio 2.6, 95% CIs 1.4-4.7, P = .002) compared to the other groups.
Among participants from a triethnic community cohort, black race was associated with greater degree of subclinical LVSD by GLS than other race-ethnic groups. This difference was independent of confounders and cardiovascular risk factors.
心力衰竭的流行病学存在种族差异，黑人的发病率更高，预后更差。通过斑点追踪整体纵向应变（GLS）检测到的左心室（LV）收缩功能障碍（LVSD）是包括心力衰竭在内的心血管事件的预测指标。在没有明显左心室功能障碍的受试者中，GLS-LVSD是否存在种族差异尚不清楚。
来自一项基于三族裔社区的研究的参与者接受了二维超声心动图检查，通过斑点追踪评估左心室射血分数（LVEF）和GLS。排除LVEF<50%的参与者。通过GLS定义的左心室收缩功能障碍定义为在健康样本中GLS>第95百分位数（-14.7%）。
在678名研究参与者（平均年龄71±9岁，61%为女性）中，114人为黑人；464人为西班牙裔；100人为白人。在单变量分析（P = 0.015）和多变量分析（P = 0.011）中，黑人的整体纵向应变（-16.5%±3.5%）显著低于白人（-17.5%±3.0%）和西班牙裔（-17.3%±2.9%），而三组之间的LVEF无显著差异（分别为64.3%±4.6%、63.4%±4.9%、64.7%±4.9%，单变量P = 0.064，多变量P = 0.291）。通过GLS诊断的左心室收缩功能障碍在黑人中（27.2%）比在白人中（19.0%）和西班牙裔中（14.9%）更常见（P = 0.008）。在针对混杂因素和心血管危险因素进行调整的多变量分析中，与其他组相比，黑人发生GLS-LVSD的可能性显著更高（调整后的优势比为2.6，95%置信区间为1.4-4.7，P = 0.002）。
在一个三族裔社区队列的参与者中，与其他种族群体相比，黑人种族与通过GLS检测到的更严重程度的亚临床LVSD相关。这种差异独立于混杂因素和心血管危险因素。
