Arenas Ivan A, Mihos Christos G, DeFaria Yeh Doreen, Yucel Evin, Elmahdy Hany M, Santana Orlando
Echocardiography Laboratory, Division of Cardiology, Columbia University, Mount Sinai Heart Institute, Miami Beach, FL, USA.
Adult Congenital Heart Disease Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Echocardiography. 2018 Jul;35(7):941-948. doi: 10.1111/echo.13873. Epub 2018 Mar 25.
Left ventricular noncompaction (LVNC) is associated with progressive LV systolic dysfunction and dilated cardiomyopathy. We aimed to investigate the echocardiographic and clinical characteristics associated with LV ejection fraction (LVEF) and moderate or greater systolic dysfunction in patients with LVNC.
Our institutional echocardiography database was retrospectively reviewed between 2008 and 2014, and 62 patients with LVNC were identified. Forty-three (69%) had moderate or greater LV systolic dysfunction (LVEF ≤ 40%) and were compared with 19 (31%) patients with preserved or mildly reduced LVEF (>40%). Linear regression analyses were utilized to identify markers associated with LVEF.
The mean age was 63 ± 17 years and noncompacted-to-compacted ratio was 2.3 ± 0.5, and was larger in patients with LVEF ≤ 40% (2.4 vs 2.1; P = .02). Patients with LVEF ≤ 40% were older, had more congestive heart failure, significant QRS interval prolongation, and greater LV remodeling and worse mean global longitudinal strain (GLS). Multivariate regression analysis revealed increased age (standardized regression coefficient (β) = -0.17; P = .04) and QRS duration (β = -0.13; P = .08), congestive heart failure (β = -0.18; P = .04), and worsened GLS (β = -0.40; P = .001) were independently associated with decreased LVEF in the cohort (overall model fit R = 0.71; P < .0001). Increased age (β = -0.49; P = .01) and QRS duration (β = -0.50; P = .002), and worsened GLS (β = -0.33; P = .04), were also associated with a lower LVEF in patients with LVEF > 40%.
The independent markers associated with LVEF and moderate or greater LV systolic dysfunction in patients with LVNC, in particular GLS and QRS duration, may detect high-risk candidates for more aggressive clinical surveillance and medical therapy.
左心室心肌致密化不全（LVNC）与进行性左心室收缩功能障碍及扩张型心肌病相关。我们旨在研究LVNC患者中与左心室射血分数（LVEF）及中度或更严重收缩功能障碍相关的超声心动图和临床特征。
对2008年至2014年间我院的超声心动图数据库进行回顾性分析，确定62例LVNC患者。其中43例（69%）存在中度或更严重的左心室收缩功能障碍（LVEF≤40%），并与19例（31%）LVEF保留或轻度降低（>40%）的患者进行比较。采用线性回归分析确定与LVEF相关的指标。
平均年龄为63±17岁，心肌致密化不全与致密化心肌厚度比值为2.3±0.5，在LVEF≤40%的患者中更大（2.4对2.1；P=0.02）。LVEF≤40%的患者年龄更大，充血性心力衰竭更多，QRS间期显著延长，左心室重构更明显，平均整体纵向应变（GLS）更差。多因素回归分析显示，年龄增加（标准化回归系数（β）=-0.17；P=0.04）、QRS时限（β=-0.13；P=0.08）、充血性心力衰竭（β=-0.18；P=0.04）及GLS恶化（β=-0.40；P=0.001）与队列中LVEF降低独立相关（总体模型拟合R=0.71；P<0.0001）。在LVEF>40%的患者中，年龄增加（β=-0.49；P=0.01）、QRS时限（β=-0.50；P=0.002）及GLS恶化（β=-0.33；P=0.04）也与较低的LVEF相关。
LVNC患者中与LVEF及中度或更严重左心室收缩功能障碍相关的独立指标，尤其是GLS和QRS时限，可能有助于识别需要更积极临床监测和药物治疗的高危患者。
