Kim Sung-Ai, Son Jungwoo, Shim Chi-Young, Choi Eui-Young, Ha Jong-Won
Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea.
Division of Cardiology, Severance Cardiovascular Hospital, Severance Biomedical Institute, Yonsei University College of Medicine, Seodaemun-GuShinchon-Dong 134, Seoul, 120-752, South Korea.
Int J Cardiovasc Imaging. 2017 Sep;33(9):1377-1384. doi: 10.1007/s10554-017-1122-2. Epub 2017 Mar 27.
A mid-diastolic L wave has been recognized as a marker of advanced left ventricular (LV) diastolic dysfunction. However, its prognostic implication is unclear. This study assessed long-term prognosis and independent predictors of adverse outcomes in patients with a mid-diastolic L wave. A total of 144 consecutive patients (mean age 63 ± 12 years, 88 female) with a mid-diastolic L wave of ≥0.2 m/s and in sinus rhythm were identified. Patients with significant valvular heart disease, low LV ejection fraction and arrhythmias were excluded. Subjects were followed up for cardiovascular (CV) mortality and hospitalization for heart failure (HF). During follow-up for a median of 44 months (1-76), CV deaths and hospitalization for HF occurred in 41 (28%) patients. In multivariate Cox analysis, age (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.02-1.11; p = 0.001), log N-terminal pro-brain natriuretic peptide (NT-proBNP)(HR 3.81; 95% CI 1.78-8.15; p = 0.001), and left atrial volume index (HR 1.02; 95% CI 1.01-1.04; p = 0.019) were independent predictors of adverse outcomes in patients with a mid-diastolic L wave. In a stepwise model, NT-proBNP showed an incremental prognostic value for prediction of adverse outcomes when added to the clinical and echocardiographic parameters (Chi square from 30.1 to 41.1, p < 0.001). Patients with a mid-diastolic L wave and clinical, biochemical, and echocardiographic evidence of advanced diastolic dysfunction showed poor long-term clinical outcome.
舒张中期L波已被认为是晚期左心室（LV）舒张功能障碍的一个标志物。然而，其预后意义尚不清楚。本研究评估了舒张中期L波患者的长期预后及不良结局的独立预测因素。共纳入了144例连续的舒张中期L波≥0.2 m/s且为窦性心律的患者（平均年龄63±12岁，女性88例）。排除患有严重瓣膜性心脏病、低左心室射血分数和心律失常的患者。对受试者进行心血管（CV）死亡率和因心力衰竭（HF）住院情况的随访。在中位随访44个月（1 - 76个月）期间，41例（28%）患者发生了CV死亡和因HF住院。在多变量Cox分析中，年龄（风险比[HR]，1.07；95%置信区间[CI]，1.02 - 1.11；p = 0.001）、对数N末端脑钠肽前体（NT-proBNP）（HR 3.81；95% CI 1.78 - 8.15；p = 0.001）和左心房容积指数（HR 1.02；95% CI 1.01 - 1.04；p = 0.019）是舒张中期L波患者不良结局的独立预测因素。在逐步模型中，当将NT-proBNP添加到临床和超声心动图参数中时，其对不良结局预测具有增量预后价值（卡方值从30.1增加到41.1，p < 0.001）。有舒张中期L波及晚期舒张功能障碍临床、生化和超声心动图证据的患者长期临床结局较差。
