Copenhagen City Heart Study, Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Afd. 2141, Copenhagen, Denmark
Copenhagen City Heart Study, Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark Department of Cardiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
Eur Heart J Cardiovasc Imaging. 2015 Dec;16(12):1331-7. doi: 10.1093/ehjci/jev180. Epub 2015 Jul 22.
To improve risk prediction of cardiovascular morbidity and mortality, we need sensitive markers of cardiac dysfunction; Echocardiographic Tissue Doppler Imaging (TDI) is feasible and harmless and may be ideal for this purpose.
Within the community-based Copenhagen City Heart Study, 2064 participants were examined by echocardiography including TDI and followed (median 10.9 years) with regard to cardiovascular death, heart failure, or acute myocardial infarction (n = 277). Impaired systolic (s') and diastolic (e' and a') function according to age and sex as assessed by TDI was associated with increased risk of the combined end point, even in the subgroup of persons with a normal conventional echocardiographic examination [per 1 cm/s decrease: s': HR 1.32 (1.12-1.57), P < 0.001; e': HR 1.17(1.04-1.31), P < 0.01; a': HR 1.17 (1.06-1.30), P < 0.005]. Interestingly, reduced early diastolic myocardial velocity (e') was associated with risk of acute myocardial infarction, whereas reduced systolic (s') or late diastolic function (a') was associated with heart failure and cardiovascular death independently of traditional risk factors, plasma proBNP, and conventional echocardiographic measures. Combining information on early and late diastolic function by TDI provided incremental prognostic information and improved risk classification (net reclassification improvement: 27%; P < 0.001) and remained a significant predictor of the combined end point even in the subgroup with a normal conventional echocardiographic examination [per cm/s decrease: HR 1.18 (1.08-1.28), P < 0.001].
In the general population, TDI identifies individuals with cardiac dysfunction and high risk of cardiovascular morbidity and mortality independently of traditional risk factors, even in persons with a normal conventional echocardiographic examination.
为了提高心血管疾病发病率和死亡率的风险预测能力，我们需要寻找更敏感的心功能障碍标志物；超声心动图组织多普勒成像（TDI）可行且无害，可能是理想的选择。
在基于社区的哥本哈根城市心脏研究中，对 2064 名参与者进行了超声心动图检查，包括 TDI，并对他们进行了随访（中位时间为 10.9 年），随访终点为心血管死亡、心力衰竭或急性心肌梗死（n=277）。根据 TDI 评估，与年龄和性别相关的收缩期（s'）和舒张期（e'和 a'）功能障碍与复合终点风险增加相关，即使在常规超声心动图检查正常的亚组中也是如此[每降低 1cm/s：s'：HR 1.32（1.12-1.57），P<0.001；e'：HR 1.17（1.04-1.31），P<0.01；a'：HR 1.17（1.06-1.30），P<0.005]。有趣的是，早期舒张心肌速度（e'）降低与急性心肌梗死风险相关，而收缩期（s'）或晚期舒张功能（a'）降低与心力衰竭和心血管死亡相关，独立于传统危险因素、血浆 proBNP 和常规超声心动图测量。通过 TDI 结合早期和晚期舒张功能信息提供了增量预后信息，并改善了风险分类（净重新分类改善：27%；P<0.001），即使在常规超声心动图检查正常的亚组中，这也是复合终点的显著预测因素[每降低 1cm/s：HR 1.18（1.08-1.28），P<0.001]。
在普通人群中，TDI 可识别出存在心功能障碍且心血管发病率和死亡率风险较高的个体，独立于传统危险因素，甚至在常规超声心动图检查正常的个体中也是如此。
