Kuznetsova Tatiana, Cauwenberghs Nicholas, Knez Judita, Yang Wen-Yi, Herbots Lieven, D'hooge Jan, Haddad Francois, Thijs Lutgarde, Voigt Jens-Uwe, Staessen Jan A
From the Research Unit Hypertension and Cardiovascular Epidemiology (T.K., N.C., J.K., W.-Y.Y., L.T., J.A.S.), the Division of Cardiovascular Imaging and Dynamics (L.H., J.D.), and the Division of Cardiology (J.-U.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium; and Stanford University School of Medicine, and Stanford Cardiovascular Institute, CA (F.H.).
Circ Cardiovasc Imaging. 2016 Jul;9(7). doi: 10.1161/CIRCIMAGING.116.004661.
Techniques of 2-dimensional speckle tracking enable the measurement of myocardial deformation (strain) during systole. Recent clinical studies explored the prognostic role of left ventricular global longitudinal strain (GLS). However, there are few data on the association between cardiovascular outcome and GLS in the community. Therefore, we hypothesized that GLS contains additive prognostic information over and beyond traditional cardiovascular risk factors in a large, population-based cohort.
We measured GLS by 2-dimensional speckle tracking in the apical 4-chamber view in 791 participants (mean age 50.9 years). We calculated multivariable adjusted hazard ratios for midwall, endocardial, and epicardial GLS, while accounting for family cluster and cardiovascular risk factors. Median follow-up was 7.9 years (5th to 95th percentile, 3.7-9.6). In continuous analysis, with adjustments applied for covariables, midwall, endocardial, and epicardial GLS were significant predictors of fatal and nonfatal cardiovascular (n=96; P<0.0001) and cardiac events (n=68; P≤0.001). In the sex-specific low quartile of midwall GLS (<18.8% in women and <17.4% in men), the risk was significantly higher than the average population risk for cardiovascular (128%, P<0.0001) and cardiac (94%, P=0.0007) events. We also noticed that the risk for cardiovascular events increased with increasing number of left ventricular abnormalities, such as low GLS, diastolic dysfunction, and hypertrophy (log-rank P<0.0001).
Low GLS measured by 2-dimensional speckle tracking predicts future cardiovascular events independent of conventional risk factors. Left ventricular midwall strain represents a simple echocardiographic measure, which might be used for assessing cardiovascular risk in a population-based cohort.
二维斑点追踪技术能够测量收缩期心肌变形（应变）。近期临床研究探讨了左心室整体纵向应变（GLS）的预后作用。然而，关于社区人群中心血管结局与GLS之间关联的数据较少。因此，我们假设在一个大型的基于人群的队列中，GLS包含超越传统心血管危险因素的附加预后信息。
我们通过二维斑点追踪技术在791名参与者（平均年龄50.9岁）的心尖四腔视图中测量了GLS。我们计算了中层心肌、心内膜和心外膜GLS的多变量调整风险比，同时考虑了家族聚集和心血管危险因素。中位随访时间为7.9年（第5至95百分位数，3.7 - 9.6年）。在连续分析中，对协变量进行调整后，中层心肌、心内膜和心外膜GLS是致命和非致命心血管事件（n = 96；P < 0.0001）和心脏事件（n = 68；P≤0.001）的显著预测因子。在中层心肌GLS的性别特异性低四分位数中（女性<18.8%，男性<17.4%），心血管事件（128%，P < 0.0001）和心脏事件（94%，P = 0.0007）的风险显著高于平均人群风险。我们还注意到，心血管事件的风险随着左心室异常数量的增加而增加，如低GLS、舒张功能障碍和肥厚（对数秩检验P < 0.0001）。
通过二维斑点追踪技术测量的低GLS可独立于传统危险因素预测未来心血管事件。左心室中层心肌应变代表一种简单的超声心动图测量方法，可用于评估基于人群队列中的心血管风险。
