Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital.
Department of Hygiene and Preventive Medicine, Showa University School of Medicine.
Circ J. 2019 Mar 25;83(4):801-808. doi: 10.1253/circj.CJ-18-0554. Epub 2019 Feb 13.
The prognostic value of indices for left atrial volumes (LAV) and reservoir function measured by 3D speckle-tracking analysis (3DSTA) has not been determined.
LA maximal and minimal volume indices (LAVImax, LAVImin), and LA emptying fraction (LAEmpF) were measured via 2D echocardiography (2DE) and 3DSTA in 514 patients (62% male, mean age: 66±15 years) with various cardiovascular diseases. Two cutoff values using normal±2SD (cutoff criterion 1) and receiver-operating characteristic analysis (cutoff criterion 2) were evaluated. During a mean follow-up of 720±383 days, MACE (cardiac death, nonfatal myocardial infarction, stroke and admission for heart failure) occurred in 98 patients. Kaplan-Meier survival analysis showed both cutoff criteria measured by 2DE and 3DSTA had significant predictive power for MACE (P<0.001). For cutoff criterion 1, 3DSTA measurements yielded higher hazard ratios than 2DE by Cox proportional hazard model. Cutoff criterion 2 using 3DSTA had higher average treatment effect values than 2DE by matching propensity scores on the outcome. Further, a regression model that included clinical variables, left ventricular ejection fraction and cutoff criterion 2 using 3DSTA-derived LAEmpF had significantly higher prognostic power than 2DE.
LA indices measured by 3DSTA had greater prognostic power for future MACE than 2DE. In particular, 3DSTA-derived LAEmpF has the potential to be a valuable prognostic tool in clinical settings.
通过三维斑点追踪分析（3DSTA）测量的左心房容积（LAV）和储器功能指数的预后价值尚未确定。
通过二维超声心动图（2DE）和 3DSTA 在 514 例（62%为男性，平均年龄：66±15 岁）患有各种心血管疾病的患者中测量了 LA 最大和最小容积指数（LAVImax、LAVImin）和 LA 排空分数（LAEmpF）。使用正常±2SD（截断标准 1）和受试者工作特征分析（截断标准 2）评估了两种截断值。在平均 720±383 天的随访期间，98 例患者发生了 MACE（心脏死亡、非致死性心肌梗死、卒中和心力衰竭入院）。Kaplan-Meier 生存分析显示，2DE 和 3DSTA 测量的两种截断标准均对 MACE 具有显著的预测能力（P<0.001）。对于截断标准 1，Cox 比例风险模型显示 3DSTA 测量的风险比 2DE 更高。通过匹配倾向性评分，使用 3DSTA 的截断标准 2 比 2DE 具有更高的平均治疗效果值。此外，包括临床变量、左心室射血分数和 3DSTA 衍生的 LAEmpF 截断标准 2 的回归模型对未来 MACE 的预后能力明显高于 2DE。
通过 3DSTA 测量的 LA 指数对未来发生 MACE 的预测能力优于 2DE。特别是，3DSTA 衍生的 LAEmpF 具有成为临床环境中一种有价值的预后工具的潜力。
