Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark; Division of Cardiology, University of California, San Francisco UCSF.
Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark.
J Card Fail. 2019 Nov;25(11):877-885. doi: 10.1016/j.cardfail.2019.07.007. Epub 2019 Jul 20.
The ratio of early mitral inflow velocity to global diastolic strain rate (E/e'sr) has recently emerged as a novel measure of left ventricular (LV) filling pressure. This new measure has demonstrated to have prognostic value superior to E/e'. This study aimed to investigate the prognostic value of E/e'sr in a large cohort of patients with heart failure with reduced ejection fraction (HFrEF) in relation to all-cause mortality.
We retrospectively studied 897 HFrEF (mean age 66 ± 12 years, 73% male, 59% ischemic cardiomyopathy) patients who underwent speckle tracking echocardiography where E/e'sr along with novel and conventional echocardiographic parameters were obtained. The primary endpoint was defined as all-cause mortality.
During follow-up (median: 40 months IQR: 22-57), 137 (15.3%) patients died. Both E/e'sr and E/e' were significantly associated with mortality (E/e'sr: HR 1.03 95%CI [1.02-1.04], p<0.001, per 0.10m increase) and (E/e': HR 1.04 95%CI [1.02-1.06], p = 0.001, per 1unit increase). E/e'sr remained an independent predictor in a multivariable model after adjusting for age, gender, mean arterial pressure, heart rate, BMI, total cholesterol, diabetes mellitus, ischemic cardiomyopathy, LVEF, LVIDd, LVMI, LAVI, TAPSE and LV-GLS (HR 1.02 95%CI [1.01-1.03], p = 0.007) whereas E/e' did not (HR 1.01 95%CI [0.98-1.04], p = 0.57). Furthermore, E/e'sr provided incremental prognostic information beyond a model including known risk factors: age, gender, total cholesterol, mean arterial pressure, heart rate, BMI, smoking status and E/e' (Harrell's C-statistics: 0.72 (0.68-0.77) vs 0.70 (0.66-0.75), p = 0.047).
In HFrEF patients, E/e'sr provides independent and incremental prognostic information regarding all-cause mortality superior to E/e'.
早期二尖瓣流入速度与整体舒张应变率的比值（E/e'sr）最近已成为一种评估左心室充盈压的新指标。与 E/e'相比，这种新指标具有更好的预后价值。本研究旨在调查 E/e'sr 在射血分数降低的心力衰竭（HFrEF）患者中的预后价值，该研究涉及与全因死亡率相关的所有患者。
我们回顾性研究了 897 例 HFrEF（平均年龄 66 ± 12 岁，73%为男性，59%为缺血性心肌病）患者，这些患者接受了斑点追踪超声心动图检查，其中获取了 E/e'sr 以及新的和传统的超声心动图参数。主要终点定义为全因死亡率。
在随访期间（中位数：40 个月 IQR：22-57），137 名（15.3%）患者死亡。E/e'sr 和 E/e' 均与死亡率显著相关（E/e'sr：HR 1.03 95%CI [1.02-1.04]，p<0.001，每增加 0.10m）和（E/e'：HR 1.04 95%CI [1.02-1.06]，p=0.001，每增加 1 个单位）。在调整年龄、性别、平均动脉压、心率、BMI、总胆固醇、糖尿病、缺血性心肌病、LVEF、LVIDd、LVMI、LAVI、TAPSE 和 LV-GLS 后，E/e'sr 在多变量模型中仍然是独立的预测因子（HR 1.02 95%CI [1.01-1.03]，p=0.007），而 E/e'则不然（HR 1.01 95%CI [0.98-1.04]，p=0.57）。此外，E/e'sr 提供了比包括已知危险因素在内的模型更具预后价值的信息：年龄、性别、总胆固醇、平均动脉压、心率、BMI、吸烟状况和 E/e'（哈雷尔 C 统计量：0.72（0.68-0.77）比 0.70（0.66-0.75），p=0.047）。
在 HFrEF 患者中，E/e'sr 提供了独立且具有增量预后价值的全因死亡率信息，优于 E/e'。
