Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; Division of Cardiology, University of California, San Francisco, California.
Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
Am J Cardiol. 2019 Jun 1;123(11):1776-1782. doi: 10.1016/j.amjcard.2019.03.004. Epub 2019 Mar 9.
The ratio of early mitral inflow velocity (E) to early diastolic strain rate (E/e'sr) is a significant predictor of cardiac outcomes in various patient populations. This study aims to evaluate the predictive value of E/e'sr for heart failure, acute myocardial infarction, and death due to cardiovascular disease following acute coronary syndrome (ACS). In total, 432 ACS patients underwent echocardiography following percutaneous coronary intervention. The end point was the composite of heart failure, acute myocardial infarction, and death due to cardiovascular disease. Median follow-up was 4.4 (interquartile range 0.2 to 6.3) years. During the follow-up period, 199 (46.1%) met the composite outcome. Mean value of E/e'sr in patients was 0.70 ± 0.37 m. In univariable Cox regression, E/e'sr was a predictor of the composite outcome (hazard ratio [HR] 1.05 95% confidence interval [CI] 1.03 to 1.07, p <0.001, per 0.10 m increase). After multivariable adjustment for demographic and clinical parameters, E/e'sr remained an independent predictor (HR 1.03; 95% CI 1.01 to 1.06; p = 0.013, per 0.10 m increase). Global longitudinal strain (GLS) modified the relation between E/e'sr and outcome (p value for interaction = 0.011). In ACS patients with a relatively preserved systolic function assessed by GLS (GLS ≥ 13.2%), E/e'sr showed to be a significant predictor (HR 1.20; 95% CI 1.06 to 1.36; p = 0.005, per 0.10 m increase). In contrast, E/e'sr was not a significant predictor in ACS patients with impaired systolic function (GLS < 13.2%; HR 1.02; 95% CI 0.99 to 1.04; p = 0.28). In conclusion, E/e'sr provides important prognostic information regarding cardiovascular morbidity and mortality in ACS patients. However, E/e'sr was not an independent predictor over that of echocardiographic parameters. Furthermore, E/e'sr is a stronger prognosticator in patients with relatively preserved systolic function as opposed to patients with impaired systolic function.
早期二尖瓣血流速度（E）与早期舒张应变率（E/e'sr）的比值是各种患者群体心功能结局的重要预测指标。本研究旨在评估 E/e'sr 对急性冠状动脉综合征（ACS）后心力衰竭、急性心肌梗死和心血管疾病死亡的预测价值。共有 432 例 ACS 患者在经皮冠状动脉介入治疗后接受了超声心动图检查。终点是心力衰竭、急性心肌梗死和心血管疾病导致的死亡的复合结局。中位随访时间为 4.4 年（四分位距 0.2 至 6.3）。在随访期间，199 例（46.1%）符合复合结局。患者的 E/e'sr 平均值为 0.70 ± 0.37 m。在单变量 Cox 回归中，E/e'sr 是复合结局的预测因素（风险比 [HR] 1.05，95%置信区间 [CI] 1.03 至 1.07，p<0.001，每增加 0.10 m）。在对人口统计学和临床参数进行多变量调整后，E/e'sr 仍然是一个独立的预测因素（HR 1.03；95% CI 1.01 至 1.06；p=0.013，每增加 0.10 m）。整体纵向应变（GLS）改变了 E/e'sr 与结局之间的关系（交互作用的 p 值=0.011）。在 GLS 评估收缩功能相对保留的 ACS 患者中（GLS≥13.2%），E/e'sr 显示为显著的预测因素（HR 1.20；95% CI 1.06 至 1.36；p=0.005，每增加 0.10 m）。相反，在收缩功能受损的 ACS 患者中（GLS<13.2%），E/e'sr 不是一个显著的预测因素（HR 1.02；95% CI 0.99 至 1.04；p=0.28）。总之，E/e'sr 为 ACS 患者提供了有关心血管发病率和死亡率的重要预后信息。然而，E/e'sr 不是超声心动图参数的独立预测因素。此外，E/e'sr 在收缩功能相对保留的患者中是一个更强的预后指标，而不是在收缩功能受损的患者中。
