Minamisawa Masatoshi, Miura Takashi, Motoki Hirohiko, Ueki Yasushi, Shimizu Kunihiko, Shoin Wataru, Harada Mikiko, Mochidome Tomoaki, Yoshie Koji, Oguchi Yasutaka, Hashizume Naoto, Nishimura Hitoshi, Abe Naoyuki, Ebisawa Soichiro, Izawa Atsushi, Koyama Jun, Ikeda Uichi
Department of Cardiovascular Medicine, Shinshu University School of Medicine.
Int Heart J. 2017 Apr 6;58(2):250-256. doi: 10.1536/ihj.16-315. Epub 2017 Mar 21.
Diastolic wall strain (DWS) is based on the linear elastic theory, according to which decreased wall thinning during diastole reflects reduced left ventricular compliance and thus increased diastolic stiffness. Increased diastolic stiffness as assessed by DWS is associated with a worse prognosis in patients who have heart failure (HF) with preserved ejection fraction. However, there are no data about the prognostic value of DWS derived by M-mode echocardiography in patients at risk for HF. We retrospectively enrolled 1829 consecutive patients without prior HF who were hospitalized for cardiovascular (CV) diseases in our hospital between 2005 and 2012. Patients were divided into two groups stratified by DWS (median value 0.34). The study endpoint was the composite of major adverse cardiovascular events (MACE), including all-cause death, myocardial infarction, stroke, and hospitalization for HF. Over a 4.2-year median follow-up, adverse events were observed in 322 patients (17.6%). In Kaplan-Meier analysis, patients with low DWS (≤ 0.34, n = 915) showed worse prognoses than those with high DWS (> 0.34, n = 914) (MACE incidence 39.4% versus 31.9%, P = 0.011). In multivariate Cox proportional hazards analysis after the adjustment for age, sex, and echocardiographic parameters, low DWS (≤ 0.34) was significantly associated with the incidence of MACE (hazard ratio: 1.26, 95% confidence interval: 1.01-1.59; P = 0 .045). In patients without prior HF, DWS is an independent predictor of MACE. Simple assessment of DWS might improve risk stratification for CV events in those patients.
舒张期壁应变（DWS）基于线性弹性理论，根据该理论，舒张期壁变薄减少反映左心室顺应性降低，进而舒张期僵硬度增加。通过DWS评估的舒张期僵硬度增加与射血分数保留的心力衰竭（HF）患者预后较差相关。然而，关于M型超声心动图得出的DWS在HF风险患者中的预后价值尚无数据。我们回顾性纳入了2005年至2012年间在我院因心血管（CV）疾病住院的1829例无既往HF的连续患者。根据DWS（中位数为0.34）将患者分为两组。研究终点是主要不良心血管事件（MACE）的复合终点，包括全因死亡、心肌梗死、中风和HF住院。在中位4.2年的随访期间，322例患者（17.6%）发生了不良事件。在Kaplan-Meier分析中，低DWS（≤0.34，n = 915）的患者比高DWS（>0.34，n = 914）的患者预后更差（MACE发生率39.4%对31.9%，P = 0.011）。在对年龄、性别和超声心动图参数进行调整后的多变量Cox比例风险分析中，低DWS（≤0.34）与MACE的发生率显著相关（风险比：1.26，95%置信区间：1.01-1.59；P = 0.045）。在无既往HF的患者中，DWS是MACE的独立预测因素。对DWS进行简单评估可能会改善这些患者CV事件的风险分层。
