Hamada Sandra, Schroeder Joerg, Hoffmann Rainer, Altiok Ertunc, Keszei Andras, Almalla Mohammad, Napp Andreas, Marx Nikolaus, Becker Michael
Department of Cardiology, RWTH Aachen University, Aachen, Germany.
Department of Internal Medicine, Hospital Lingen, Lingen, Germany.
J Am Soc Echocardiogr. 2016 May;29(5):412-20. doi: 10.1016/j.echo.2016.02.001. Epub 2016 Mar 9.
Cardiac magnetic resonance imaging (CMR) has been established as a powerful tool for predicting mortality. However, its application is limited by availability and various contraindications. The aim of this study was to evaluate the predictive value of layer-specific myocardial deformation analysis as assessed by strain echocardiography for cardiac events in patients with chronic ischemic left ventricular dysfunction in comparison with CMR.
Three hundred ninety patients (mean age, 63 ± 4 years; 69% men; mean left ventricular ejection fraction [LVEF], 41 ± 7%) with chronic ischemic cardiomyopathy were prospectively enrolled and underwent strain echocardiography and CMR within 3 ± 1 days. LVEF, wall motion score index, and circumferential strain (CS), longitudinal strain, and radial strain for total wall thickness and for three myocardial layers (endocardial, midmyocardial, and epicardial) were determined by echocardiography. The extent of total myocardial scar (TMS) was determined by CMR. Follow-up was obtained for a mean of 4.9 ± 2.2 years. Cardiac events were defined as readmission for worsening of heart failure, ventricular arrhythmias, or death of any cause. The incremental value of LVEF, strain parameters, and TMS to relevant clinical variables was determined in nested Cox models.
There were 133 cardiac events (34%). Baseline clinical data associated with outcomes were age (hazard ratio [HR], 1.27; P = .04), diabetes mellitus (HR, 1.52; P = .001), and renal insufficiency (HR, 1.77; P = .001) by multivariate analysis. The addition of LVEF, global and endocardial strain parameters, and TMS increased the predictive power, but endocardial CS (HR, 1.52; P < .01) caused the greatest increment in model power (χ(2) = 39.2, P < .001). Endocardial CS < -20% was found to be the optimal predictor of prognosis.
Endocardial CS is a powerful predictor of cardiac events and appears to be a better parameter than LVEF, TMS by CMR, and other strain variables by echocardiography.
心脏磁共振成像（CMR）已成为预测死亡率的有力工具。然而，其应用受到可用性和各种禁忌症的限制。本研究的目的是评估与CMR相比，经应变超声心动图评估的层特异性心肌变形分析对慢性缺血性左心室功能不全患者心脏事件的预测价值。
前瞻性纳入390例慢性缺血性心肌病患者（平均年龄63±4岁；69%为男性；平均左心室射血分数[LVEF]为41±7%），并在3±1天内接受应变超声心动图和CMR检查。通过超声心动图测定LVEF、壁运动评分指数以及全层心肌和三个心肌层（心内膜、心肌中层和心外膜）的圆周应变（CS）、纵向应变和径向应变。通过CMR测定全心肌瘢痕（TMS）的范围。平均随访4.9±2.2年。心脏事件定义为因心力衰竭恶化、室性心律失常或任何原因死亡而再次入院。在嵌套Cox模型中确定LVEF、应变参数和TMS对相关临床变量的增量值。
发生133例心脏事件（34%）。多因素分析显示，与预后相关的基线临床数据为年龄（风险比[HR]，1.27；P = 0.04）、糖尿病（HR，1.52；P = 0.001）和肾功能不全（HR，1.77；P = 0.001）。添加LVEF、整体和心内膜应变参数以及TMS可提高预测能力，但心内膜CS（HR，1.52；P < 0.01）使模型能力增加最大（χ(2)=39.2，P < 0.001）。心内膜CS < -20%被发现是预后的最佳预测指标。
心内膜CS是心脏事件的有力预测指标，似乎比LVEF、CMR测定的TMS以及超声心动图测定的其他应变变量更好。
