Department of Cardiology, Graduate School of Comprehensive Human Sciences (Y.H.-H., S.S.), University of Tsukuba, Tsukuba, Japan.
Department of Cardiology, Faculty of Medicine (Y.S., T.I., T.M.-O., M.Y., K.S., K.A.), University of Tsukuba, Tsukuba, Japan.
Circ Cardiovasc Imaging. 2018 Oct;11(10):e007249. doi: 10.1161/CIRCIMAGING.117.007249.
Although 2-dimensional strain analyses based on speckle tracking echocardiography have been used to detect myocardial deformation, the prognostic impact of 2-dimensional strain is unclear in patients with acute decompensated heart failure (HF). We investigated whether left ventricular and right ventricular (RV) strain parameters assessed by speckle tracking echocardiography provide incremental prognostic information in hospitalized patients because of acute decompensated HF.
Six hundred eighteen patients (age, 72±13 years; 38% women; ejection fraction, 46±16%) hospitalized for acute decompensated HF underwent clinical and echocardiographic evaluation just before discharge. We performed strain analyses of left ventricular global longitudinal strain and left ventricular global circumferential strain. We also analyzed RV longitudinal strain only from the free wall (RV-fwLS) and from all segments of the RV global longitudinal strain wall by using Tomtec software. The primary composite end point was cardiovascular death and readmission for HF. There were 34.8% cardiac events during a median follow-up of 427 days. In multivariate Cox models, among echocardiographic parameters, only impaired RV-fwLS (≥-13.1%; hazard ratio, 1.51; 95% CI, 1.12-2.04; P=0.01) was independently associated with cardiac events. Adding RV-fwLS to clinical risk evaluation (age, New York Heart Association class III/IV, blood urea nitrogen, and brain natriuretic peptide) markedly improved prognostic utility and consequently increased net reclassification improvement by 0.30 ( P=0.01).
RV-fwLS is an independent predictor of cardiac events in acute decompensated HF and provides greater prognostic power than standard echocardiographic parameters.
尽管基于斑点追踪超声心动图的二维应变分析已被用于检测心肌变形，但二维应变在急性失代偿性心力衰竭（HF）患者中的预后影响尚不清楚。我们研究了斑点追踪超声心动图评估的左心室和右心室（RV）应变参数是否为急性失代偿性 HF 住院患者提供了额外的预后信息。
618 名患者（年龄 72±13 岁；38%为女性；射血分数 46±16%）因急性失代偿性 HF 住院，在出院前接受了临床和超声心动图评估。我们对左心室整体纵向应变和左心室整体周向应变进行了应变分析。我们还使用 Tomtec 软件仅分析 RV 纵向应变（RV-fwLS）和 RV 整体纵向应变壁的所有节段。主要复合终点为心血管死亡和 HF 再入院。在中位随访 427 天期间，有 34.8%的患者发生了心脏事件。在多变量 Cox 模型中，在超声心动图参数中，仅受损的 RV-fwLS（≥-13.1%；危险比，1.51；95%CI，1.12-2.04；P=0.01）与心脏事件独立相关。将 RV-fwLS 加入临床风险评估（年龄、纽约心脏协会 III/IV 级、血尿素氮和脑利钠肽）显著改善了预后效用，从而使净重新分类改善增加了 0.30（P=0.01）。
RV-fwLS 是急性失代偿性 HF 心脏事件的独立预测因子，比标准超声心动图参数提供了更大的预后价值。
