区域纵向变形改善对射血分数降低的心力衰竭患者室性快速心律失常的预测：一项MADIT-CRT子研究（多中心自动除颤器植入试验-心脏再同步治疗）
Regional Longitudinal Deformation Improves Prediction of Ventricular Tachyarrhythmias in Patients With Heart Failure With Reduced Ejection Fraction: A MADIT-CRT Substudy (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy).
作者信息
Biering-Sørensen Tor, Knappe Dorit, Pouleur Anne-Catherine, Claggett Brian, Wang Paul J, Moss Arthur J, Solomon Scott D, Kutyifa Valentina
机构信息
From the Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., D.K., A.-C.P., B.C., S.D.S.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark (T.B.-S.); Stanford University of Medicine, Palo Alto, CA (P.J.W.); and University of Rochester Medical Center, NY (A.J.M., V.K.).
出版信息
Circ Cardiovasc Imaging. 2017 Jan;10(1). doi: 10.1161/CIRCIMAGING.116.005096.
BACKGROUND
Left ventricular dysfunction is a known predictor of ventricular arrhythmias. We hypothesized that measures of regional longitudinal deformation by speckle-tracking echocardiography predict ventricular tachyarrhythmias and provide incremental prognostic information over clinical and conventional echocardiographic characteristics.
METHODS AND RESULTS
We studied 1064 patients enrolled in the MADIT-CRT trial (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy) with speckle-tracking data available. Peak longitudinal strain was obtained for the septal, lateral, anterior, and inferior myocardial walls at baseline. The end point was the first event of ventricular tachycardia (VT) or fibrillation (VF). During the median follow-up of 2.9 years, 254 (24%) patients developed VT/VF. Patients with VT/VF had significantly lower left ventricular ejection fraction (28.3% versus 29.5%; P<0.001) and longitudinal strain in all myocardial walls compared with patients without VT/VF (anterior-strain, -7.7% versus -8.8%; P<0.001; lateral-strain, -7.3% versus -7.9%; P=0.022; inferior-strain, -8.3% versus -9.9%; P<0.001; septal-strain, -9.1% versus -10.0%; P<0.001). After multivariate adjustment, only anterior and inferior longitudinal strain remained independent predictors of VT/VF (anterior: hazard ratio, 1.08 [1.03-1.13]; P=0.001; inferior: hazard ratio, 1.08 [1.04-1.12]; P<0.001; per 1% absolute decrease for both). When including B-type natriuretic peptide in the model, only a decreasing myocardial function in the inferior myocardial wall predicted VT/VF (hazard ratio, 1.05 [1.00-1.11]; P=0.039). Only strain obtained from the inferior myocardial wall provided incremental prognostic information for VT/VF over clinical and echocardiographic parameters (C statistic 0.71 versus 0.69; P=0.005).
CONCLUSIONS
Assessment of regional longitudinal myocardial deformation in the inferior region provided incremental prognostic information over clinical and echocardiographic risk factors in predicting ventricular tachyarrhythmias.
CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00180271.
背景
左心室功能障碍是已知的室性心律失常预测指标。我们假设，斑点追踪超声心动图测量的局部纵向变形指标可预测室性快速心律失常，并能提供超越临床及传统超声心动图特征的增量预后信息。
方法与结果
我们研究了1064例参与MADIT-CRT试验（多中心自动除颤器植入试验-心脏再同步治疗）且有斑点追踪数据的患者。在基线时获取室间隔、侧壁、前壁和下壁心肌的纵向应变峰值。终点为室性心动过速（VT）或颤动（VF）的首次发作。在中位随访2.9年期间，254例（24%）患者发生VT/VF。与未发生VT/VF的患者相比，发生VT/VF的患者左心室射血分数显著更低（28.3%对29.5%；P<0.001）且所有心肌壁的纵向应变均更低（前壁应变，-7.7%对-8.8%；P<0.001；侧壁应变，-7.3%对-7.9%；P=0.022；下壁应变：-8.3%对-9.9%；P<0.001；室间隔应变，-9.1%对-10.0%；P<0.001）。多变量调整后，仅前壁和下壁纵向应变仍是VT/VF的独立预测指标（前壁：风险比1.08[1.03 - 1.13]；P = 0.001；下壁：风险比1.08[1.04 - 1.12]；P<0.001；两者每降低1%绝对值）。当在模型中纳入B型利钠肽时，仅下壁心肌功能下降可预测VT/VF（风险比1.05[1.00 - 1.11]；P = 0.039）。仅下壁心肌获得的应变能提供超越临床和超声心动图参数的VT/VF增量预后信息（C统计量0.71对0.69；P = 0.005）。
结论
在下壁区域评估局部纵向心肌变形能提供超越临床和超声心动图危险因素的增量预后信息，用于预测室性快速心律失常。
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