Department of Cardiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
Department of Cardiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
JACC Cardiovasc Imaging. 2015 Dec;8(12):1351-1359. doi: 10.1016/j.jcmg.2015.07.013. Epub 2015 Nov 11.
The purpose of this study was to investigate the prognostic value of global longitudinal strain (GLS) in heart failure with reduced ejection fraction (HFrEF) patients in relation to all-cause mortality.
Measurement of myocardial deformation by 2-dimensional speckle tracking echocardiography, specifically GLS, may be superior to conventional echocardiographic parameters, including left ventricular ejection fraction, in predicting all-cause mortality in HFrEF patients.
Transthoracic echocardiographic examinations were retrieved for 1,065 HFrEF patients admitted to a heart failure clinic. The echocardiographic images were analyzed, and conventional and novel echocardiographic parameters were obtained.
Many of the conventional echocardiographic parameters proved to be predictors of mortality. However, GLS remained an independent predictor of mortality in the multivariable model after adjusting for age, sex, body mass index, total cholesterol, mean arterial pressure, heart rate, ischemic cardiomyopathy, percutaneous transluminal coronary angioplasty, coronary artery bypass graft surgery, noninsulin dependent diabetes mellitus, and conventional echocardiographic parameters (hazard ratio [HR]: 1.15; 95% confidence interval [CI]: 1.04 to 1.27; p = 0.008, per 1% decrease). No other echocardiographic parameter remained an independent predictor after adjusting for these variables. Furthermore, GLS had the highest C-statistics of all the echocardiographic parameters and added incremental prognostic value with a significant increase in the net reclassification improvement (p = 0.009). Atrial fibrillation (AF) modified the relationship between GLS and mortality (p value for interaction = 0.036); HR: 1.08 (95% CI: 0.97 to 1.19), p = 0.150 and HR: 1.22 (95% CI: 1.15 to 1.29), p < 0.001, per 1% decrease in GLS for patients with and without AF, respectively. Sex also modified the relationship between GLS and mortality (p value for interaction = 0.047); HR: 1.23 (95% CI: 1.16 to 1.30), p < 0.001 and HR: 1.09 (95% CI: 0.99 to 1.20), p = 0.083, per 1% decrease in GLS for men and women, respectively.
GLS is an independent predictor of all-cause mortality in HFrEF patients, especially in male patients without AF. Furthermore, GLS was a superior prognosticator compared with all other echocardiographic parameters.
本研究旨在探讨左心室射血分数降低的心力衰竭（HFrEF）患者整体纵向应变（GLS）与全因死亡率之间的预后价值。
二维斑点追踪超声心动图测量心肌变形，特别是 GLS，可能优于传统超声心动图参数，包括左心室射血分数，可预测 HFrEF 患者的全因死亡率。
回顾性分析了 1065 例因心力衰竭就诊的 HFrEF 患者的经胸超声心动图检查。分析超声心动图图像，获取常规和新型超声心动图参数。
许多传统超声心动图参数被证明是死亡率的预测因素。然而，在校正年龄、性别、体重指数、总胆固醇、平均动脉压、心率、缺血性心肌病、经皮冠状动脉腔内成形术、冠状动脉旁路移植术、非胰岛素依赖型糖尿病和常规超声心动图参数后，GLS 仍然是多变量模型中死亡率的独立预测因素（危险比[HR]：1.15；95%置信区间[CI]：1.04 至 1.27；p=0.008，每降低 1%）。在校正这些变量后，没有其他超声心动图参数仍然是独立的预测因素。此外，GLS 在所有超声心动图参数中的 C 统计量最高，并通过净重新分类改善显著增加而增加了增量预后价值（p=0.009）。心房颤动（AF）改变了 GLS 与死亡率之间的关系（交互作用 p 值=0.036）；每降低 1%的 GLS，HR：1.08（95%CI：0.97 至 1.19），p=0.150 和 HR：1.22（95%CI：1.15 至 1.29），p<0.001，分别在有和无 AF 的患者中。性别也改变了 GLS 与死亡率之间的关系（交互作用 p 值=0.047）；HR：1.23（95%CI：1.16 至 1.30），p<0.001 和 HR：1.09（95%CI：0.99 至 1.20），p=0.083，分别在男性和女性中每降低 1%的 GLS。
GLS 是 HFrEF 患者全因死亡率的独立预测因子，尤其是在无 AF 的男性患者中。此外，与所有其他超声心动图参数相比，GLS 是一种更好的预后预测因子。
