Valve Center, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Valve Center, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
JACC Cardiovasc Imaging. 2020 Jan;13(1 Pt 1):12-21. doi: 10.1016/j.jcmg.2018.12.021. Epub 2019 Feb 13.
This study sought to determine whether baseline left ventricular global longitudinal strain (LV-GLS) and changes in left ventricular ejection fraction (LVEF) in a subgroup of subjects at post-operative follow-up added prognostic value in patients undergoing aortic valve (AV) surgery.
In patients with chronic severe aortic regurgitation (AR) and preserved LVEF, sensitive markers are needed to decide timing of AV surgery.
This was an observational study in 865 patients (asymptomatic/mildly symptomatic, 52 ± 15 years of age, 79% men) with ≥3+ chronic AR and preserved LVEF of ≥50% who underwent AV surgery between 2003 and 2015. All patients had baseline echocardiography (and LV-GLS imaging), whereas 285 patients underwent post-operative echocardiography (including LV-GLS). Primary outcome was mortality.
Only 478 patients (56%) patients had preoperative LV-GLS values better than -19%, despite a mean LVEF of 57 ± 4%. At a median 38 days, 632 patients underwent AV replacement, whereas 233 patients had AV repair. At a median follow-up of 6.95 (interquartile range [IQR]: 5.2 to 9.1) years, 105 patients (12%) died (2% in-hospital deaths). A higher proportion of patients with baseline LV-GLS grades worse than -19% died versus those whose LV-GLS score was better (15% vs. 10%; p < 0.01), and worse LV-GLS value was independently associated with higher longer-term mortality (hazard ratio: 1.62; 95% confidence interval [CI]: 1.40 to 1.86]; p < 0.001). In the 285 patients who underwent echo at 3 to 12 months post-operatively, LVEF normalized in 91% patients; however, only 88 patients (31%) had LV-GLS values better than -19%. Patients whose follow-up LV-GLS value was better than -19% had significantly better longer-term survival than those whose LV-GLS was not (5% vs. 15%, respectively; p < 0.01). An absolute worsening of 5% of LV-GLS from baseline was associated with increased mortality.
In patients with ≥3+ chronic AR and preserved LVEF undergoing AV surgery, a baseline LV-GLS value worse than -19% was associated with reduced survival. In a subgroup of patients who returned for 3- and 12-month follow-up examinations, persistently impaired LV-GLS was associated with increased mortality.
本研究旨在探讨左心室射血分数（LVEF）在术后随访亚组中的变化和左心室整体纵向应变（LV-GLS）基线值是否在主动脉瓣（AV）手术患者中有预后价值。
对于慢性严重主动脉瓣反流（AR）和保留 LVEF 的患者，需要敏感的标志物来决定 AV 手术的时机。
这是一项观察性研究，纳入了 865 名患者（无症状/轻度症状，年龄 52 ± 15 岁，79%为男性），他们患有≥3+慢性 AR 和保留的 LVEF 大于等于 50%，于 2003 年至 2015 年期间接受了 AV 手术。所有患者均进行了基线超声心动图（包括 LV-GLS 成像）检查，而 285 名患者接受了术后超声心动图（包括 LV-GLS）检查。主要结局是死亡率。
尽管平均 LVEF 为 57 ± 4%，但仍有 478 名（56%）患者的术前 LV-GLS 值大于-19%。在中位数为 38 天的时间里，632 名患者接受了 AV 置换，而 233 名患者接受了 AV 修复。在中位数为 6.95 年（四分位距[IQR]：5.2 至 9.1）的随访中，有 105 名患者（12%）死亡（2%为院内死亡）。与 LV-GLS 评分较好的患者相比，基线 LV-GLS 分级较差（小于-19%）的患者死亡比例更高（15%比 10%；p<0.01），且较差的 LV-GLS 值与更高的长期死亡率独立相关（危险比：1.62；95%置信区间[CI]：1.40 至 1.86；p<0.001）。在 285 名在术后 3 至 12 个月进行超声心动图检查的患者中，91%的患者 LVEF 恢复正常；然而，只有 88 名（31%）患者的 LV-GLS 值大于-19%。随访时 LV-GLS 值大于-19%的患者比 LV-GLS 值不大于-19%的患者有显著更好的长期生存率（分别为 5%比 15%；p<0.01）。LV-GLS 基线值降低 5%与死亡率增加相关。
在接受 AV 手术的≥3+慢性 AR 和保留 LVEF 的患者中，LV-GLS 基线值较差（小于-19%）与生存率降低相关。在返回进行 3 至 12 个月随访检查的亚组患者中，持续受损的 LV-GLS 与死亡率增加相关。
