Cha Myung-Jin, Kim Hyun-Sook, Kim Seong Hwan, Park Jae-Hyeong, Cho Goo-Yeong
Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.
Cardiovascular Division, Department of Internal Medicine, Hallym University Medical Center, Anyang, South Korea.
PLoS One. 2017 Mar 23;12(3):e0174160. doi: 10.1371/journal.pone.0174160. eCollection 2017.
We aimed to evaluate the predictive power of longitudinal and circumferential fibers according to left ventricular ejection fraction (LVEF) in successfully reperfused acute ST elevation myocardial infarction (STEMI) patients.
Total 691 patients (age 59±13, 20% female) underwent clinical evaluation and conventional and strain echocardiography (Global longitudinal strain (GLS), global circumferential strain (GCS)). The clinical outcome was defined as the composite of death, hospitalization for heart failure, non-fatal myocardial infarction, and ventricular arrhythmia.
During a follow-up of 39±19 months, there were 47 (6.8%) clinical events. In multivariate Cox models adjusted clinical risk factors, age (HR 1.08, p = 0.001) and GLS (HR 1.37, p = 0.001) were independent predictors. The addition of GLS resulted in significant incremental improvement in the predictive value on LVEF (χ2 = 31.8→45.8, p<0.001), although GCS offers no additional benefit. In the subgroup analysis according to LVEF, adjusted with clinical factors, GLS was significant predictive for outcome for the patients with mildly depressed (LVEF 40-50%, HR 2.25, p<0.001) and significantly depressed (LVEF<40%, HR 1.28, p = 0.016) systolic function, although GCS and LVEF lost their power with LVEF<40%. For the patients with preserved LVEF (>50%), GLS, GCS and LVEF did not show significant predictive power.
GLS is a most powerful predictor of outcome in successfully reperfused STEMI patients, especially with depressed LV dysfunction, although GCS and LVEF lost their predictive power for the patients with significantly depressed LV function. However, GLS did not predict outcome for the patients with preserved LVEF (>50%).
我们旨在评估成功再灌注的急性ST段抬高型心肌梗死（STEMI）患者中，纵向和圆周纤维根据左心室射血分数（LVEF）的预测能力。
总共691例患者（年龄59±13岁，20%为女性）接受了临床评估以及常规和应变超声心动图检查（整体纵向应变（GLS）、整体圆周应变（GCS））。临床结局定义为死亡、因心力衰竭住院、非致命性心肌梗死和室性心律失常的综合情况。
在39±19个月的随访期间，发生了47例（6.8%）临床事件。在调整了临床危险因素的多变量Cox模型中，年龄（风险比[HR]1.08，p = 0.001）和GLS（HR 1.37，p = 0.001）是独立预测因素。尽管GCS没有额外益处，但加入GLS后，对LVEF的预测价值有显著的增量改善（χ2 = 31.8→45.8，p<0.001）。在根据LVEF进行并经临床因素调整的亚组分析中，对于收缩功能轻度降低（LVEF 40 - 50%，HR 2.25，p<0.001）和显著降低（LVEF<40%，HR 1.28，p = 0.016）的患者，GLS对结局有显著预测作用，尽管当LVEF<40%时，GCS和LVEF失去了预测能力。对于LVEF保留（>50%）的患者，GLS、GCS和LVEF均未显示出显著的预测能力。
GLS是成功再灌注的STEMI患者结局的最强有力预测因素，尤其是对于左心室功能降低的患者，尽管对于左心室功能显著降低的患者，GCS和LVEF失去了预测能力。然而，GLS对LVEF保留（>50%）的患者不能预测结局。
