Universidade Federal de Pernambuco - Ciências da Saúde, Recife, PE - Brazil.
Universidade Federal de Pernambuco - Fisioterapia, Recife, PE - Brazil.
Arq Bras Cardiol. 2019 Jul 18;113(2):188-194. doi: 10.5935/abc.20190119.
Left ventricular global longitudinal strain value (GLS) can predict functional capacity in patients with preserved left ventricular ejection fraction (LVEF) heart failure (HF) and to assess prognosis in reduced LVEF HF.
Correlate GLS with parameters of Cardiopulmonary Exercise Test (CPET) and to assess if they could predict systolic HF patients that are more appropriated to be referred to heart transplantation according to CPET criteria.
Systolic HF patients with LVEF < 45%, NYHA functional class II and III, underwent prospectively CPET and echocardiography with strain analysis. LVEF and GLS were correlated with the following CPET variables: maxVO2, VE/VCO2 slope, heart rate reduction during the first minute of recovery (HRR) and time needed to reduce maxVO2 in 50% after physical exercise (T1/2VO2). ROC curve analysis of GLS to predict VO2 < 14 mL/kg/min and VE/VCO2 slope > 35 (heart transplantation's criteria) was performed.
Twenty six patients were selected (age, 47 ± 12 years, 58% men, mean LVEF = 28 ± 8%). LVEF correlated only with maxVO2 and T1/2VO2. GLS correlated to all CPET variables (maxVO2: r = 0.671, p = 0.001; VE/VCO2 slope: r = -0.513, p = 0.007; HRR: r = 0.466, p = 0.016, and T1/2VO2: r = -0.696, p = 0.001). GLS area under the ROC curve to predict heart transplantation's criteria was 0.88 (sensitivity 75%, specificity 83%) for a cut-off value of -5.7%, p = 0.03.
GLS was significantly associated with all functional CPET parameters. It could classify HF patients according to the functional capacity and may stratify which patients have a poor prognosis and therefore to deserve more differentiated treatment, such as heart transplantation.
左心室整体纵向应变值（GLS）可预测射血分数保留的心力衰竭（HF）患者的功能能力，并评估射血分数降低的 HF 患者的预后。
将 GLS 与心肺运动试验（CPET）的参数相关联，并评估它们是否可以预测收缩性 HF 患者，根据 CPET 标准，这些患者更适合进行心脏移植。
26 例射血分数<45%、NYHA 心功能 II 级和 III 级的收缩性 HF 患者前瞻性地进行了 CPET 和应变分析。将 LVEF 和 GLS 与以下 CPET 变量相关联：最大摄氧量（maxVO2）、VE/VCO2 斜率、运动后第 1 分钟的心率下降（HRR）和运动后 50%最大 VO2 所需的时间（T1/2VO2）。对 GLS 预测 VO2<14 mL/kg/min 和 VE/VCO2 斜率>35（心脏移植的标准）的 ROC 曲线进行分析。
入选 26 例患者（年龄 47±12 岁，58%为男性，平均 LVEF=28±8%）。LVEF 仅与 maxVO2 和 T1/2VO2 相关。GLS 与所有 CPET 变量相关（maxVO2：r=0.671，p=0.001；VE/VCO2 斜率：r=-0.513，p=0.007；HRR：r=0.466，p=0.016，T1/2VO2：r=-0.696，p=0.001）。GLS 的 ROC 曲线下面积为 0.88（敏感性 75%，特异性 83%），截断值为-5.7%，p=0.03。
GLS 与所有功能 CPET 参数显著相关。它可以根据功能能力对 HF 患者进行分类，并且可以对预后不良的患者进行分层，从而需要更有针对性的治疗，例如心脏移植。
