Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark.
Eur J Heart Fail. 2017 Aug;19(8):1043-1052. doi: 10.1002/ejhf.789. Epub 2017 Mar 21.
Left ventricular mechanical dyssynchrony has been described in heart failure with preserved ejection fraction (HFpEF), but its prognostic significance is not known.
Of 3445 patients with HFpEF enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial, dyssynchrony analysis was performed on 424 patients (12%) by multiple speckle tracking echocardiography strain-based criteria. The primary dyssynchrony analysis was the standard deviation of the time to peak longitudinal strain (SD T2P LS). Cox proportional hazards models assessed the association of dyssynchrony with the composite outcome of cardiovascular death or heart failure hospitalization. Mean age was 70 ± 10 years, LVEF was 60 ± 8%, and QRS duration was 101 ± 27 ms. Worse dyssynchrony, reflected in SD T2P LS, was associated with wider QRS, prior myocardial infarction, larger LV volume and mass, and worse systolic (lower LVEF and global longitudinal strain) and diastolic (lower e' and higher E/e') function. During a median follow-up of 2.6 (interquartile range 1.5-3.8) years, 107 patients experienced the composite outcome. Worse dyssynchrony was associated with the composite outcome in unadjusted analysis [hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.01-1.07; P = 0.021, per 10 ms increase], but not after adjusting for clinical characteristics, or after further adjustment for LVEF, AF, NYHA class, stroke, heart rate, creatinine, haematocrit, and QRS duration (HR 1.03, 95% CI 0.99-1.06; P = 0.16, per 10 ms increase).
Worse LV mechanical dyssynchrony, assessed by speckle tracking echocardiography, is not an independent predictor of adverse outcomes in HFpEF, suggesting that mechanical dyssynchrony is unlikely to be an important mechanism underlying this syndrome. These findings warrant validation in an independent study specifically designed to assess the prognostic utility of mechanical dyssynchrony in HFpEF.
NCT00094302.
左心室机械不同步在射血分数保留的心力衰竭（HFpEF）中已有描述，但它的预后意义尚不清楚。
在治疗保留心脏功能心力衰竭的醛固酮拮抗剂（TOPCAT）试验中，共有 3445 例 HFpEF 患者，其中 424 例（12%）通过基于多点追踪超声心动图应变的标准进行了不同步分析。主要的不同步分析是纵向应变达峰时间标准差（SD T2P LS）。Cox 比例风险模型评估了不同步与心血管死亡或心力衰竭住院的复合终点之间的关联。平均年龄为 70±10 岁，LVEF 为 60±8%，QRS 持续时间为 101±27ms。更差的不同步，反映在 SD T2P LS 中，与更宽的 QRS、先前的心肌梗死、更大的 LV 容积和质量以及更差的收缩功能（更低的 LVEF 和整体纵向应变）和舒张功能（更低的 e'和更高的 E/e'）有关。在中位数为 2.6 年（四分位间距 1.5-3.8）的随访期间，有 107 例患者发生了复合终点事件。在未经调整的分析中，更差的不同步与复合终点相关[风险比（HR）1.04，95%置信区间（CI）1.01-1.07；P=0.021，每增加 10ms]，但在调整临床特征后，或在进一步调整 LVEF、AF、NYHA 分级、卒中和心率、肌酐、血细胞比容和 QRS 持续时间后，这种相关性不再存在（HR 1.03，95%CI 0.99-1.06；P=0.16，每增加 10ms）。
通过斑点追踪超声心动图评估的更差的 LV 机械不同步不是 HFpEF 不良结局的独立预测因子，这表明机械不同步不太可能是该综合征的重要机制。这些发现需要在一项专门设计用于评估 HFpEF 中机械不同步预后效用的独立研究中进行验证。
NCT00094302。
