Romano Simone, Mansour Ibrahim N, Kansal Mayank, Gheith Hana, Dowdy Zachary, Dickens Carolyn A, Buto-Colletti Cassandra, Chae June M, Saleh Hussam H, Stamos Thomas D
Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S. Wood Street, M/C 715, Chicago, IL, 60612, USA.
Department of Medicine, University of Verona, Ospedale policlinico Borgo Roma, Piazzale scuro 10, 37134, Verona, Italy.
Cardiovasc Ultrasound. 2017 Mar 15;15(1):6. doi: 10.1186/s12947-017-0098-3.
The goal of this study was to determine if left ventricular (LV) global longitudinal strain (GLS) predicts heart failure (HF) readmission in patients with acute decompensated heart failure.
Two hundred ninety one patients were enrolled at the time of admission for acute decompensated heart failure between January 2011 and September 2013. Left ventricle global longitudinal strain (LV GLS) by velocity vector imaging averaged from 2, 3 and 4-chamber views could be assessed in 204 out of 291 (70%) patients. Mean age was 63.8 ± 15.2 years, 42% of the patients were males and 78% were African American or Hispanic. Patients were followed until the first HF hospital readmission up to 44 months. Patients were grouped into quartiles on the basis of LV GLS. Kaplan-Meier curves showed significantly higher readmission rates in patients with worse LV GLS (log-rank p < 0.001). After adjusting for age, sex, history of ischemic heart disease, dementia, New York Heart Association class, LV ejection fraction, use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers, systolic and diastolic blood pressure on admission and sodium level on admission, worse LV GLS was the strongest predictor of recurrent HF readmission (p < 0.001). The ejection fraction was predictive of readmission in univariate, but not in multivariate analysis.
LV GLS is an independent predictor of HF readmission after acute decompensated heart failure with a higher risk of readmission in case of progressive worsening of LV GLS, independent of the ejection fraction.
本研究的目的是确定左心室（LV）整体纵向应变（GLS）是否能预测急性失代偿性心力衰竭患者的心力衰竭（HF）再入院情况。
2011年1月至2013年9月期间，291例急性失代偿性心力衰竭患者在入院时被纳入研究。通过速度向量成像从2、3和4腔视图平均得出的左心室整体纵向应变（LV GLS），在291例患者中的204例（70%）中可以进行评估。平均年龄为63.8±15.2岁，42%的患者为男性，78%为非裔美国人或西班牙裔。对患者进行随访，直至首次因心力衰竭再次入院，最长随访44个月。根据LV GLS将患者分为四分位数。Kaplan-Meier曲线显示，LV GLS较差的患者再入院率显著更高（对数秩检验p<0.001）。在调整年龄、性别、缺血性心脏病史、痴呆、纽约心脏协会分级、左心室射血分数、使用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂、入院时收缩压和舒张压以及入院时钠水平后，较差的LV GLS是复发性心力衰竭再入院的最强预测因素（p<0.001）。射血分数在单变量分析中可预测再入院情况，但在多变量分析中则不然。
LV GLS是急性失代偿性心力衰竭后HF再入院的独立预测因素，LV GLS进行性恶化时再入院风险更高，且与射血分数无关。
