Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy.
Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy.
J Am Soc Echocardiogr. 2019 Nov;32(11):1436-1443. doi: 10.1016/j.echo.2019.07.006. Epub 2019 Sep 21.
Patients with symptomatic heart failure (HF), reduced left ventricular ejection fraction (LVEF), and high-grade functional mitral regurgitation (MR) may benefit from percutaneous edge-to-edge mitral valve repair (PMVR). However, patient selection still remains a central issue. We sought to investigate the potential role of the global longitudinal strain- (GLS-) based left ventricular contractile reserve (LVCR) at dobutamine stress echocardiography (DSE) in this setting.
Thirty-three stable HF patients (MR grade ≥ 3+; median LVEF, 29%; median GLS, -8.3%) who were candidates for PMVR were prospectively enrolled. All patients underwent DSE to assess LVCR (LVEF increase ≥ 5%; GLS increase ≥ 2%; stroke volume [SV] increase ≥ 20% of the measured SV value).
After DSE, a positive LVCR was detected in 21 patients (64%), positive LVCR in 12 patients (36%), and positive LVCR in 14 patients (42%). LVCR was associated with better symptom relief, MR improvement, and LV reverse remodeling in a short-term follow-up. A significant improvement of GLS during DSE (hazard ratio [HR], 0.549; 95% CI, 0.395-0.765; P < .001), along with history of HF hospitalization (HR, 1.48; 95% CI, 1.119-1.967; P = .006) and beta-blocker therapy (HR, 0.146; 95% CI, 0.046-0.462; P = .001), were independently associated with risk of death/heart transplantation/HF-related hospitalizations.
LVCR, assessed by speckle-tracking DSE, is associated with better results after PMVR in the setting of advanced HF. Improvement of longitudinal function emerged, beyond the ejection fraction, as an independent predictor of outcomes and could improve the selection of best candidates for the percutaneous correction of functional MR.
对于有症状的心力衰竭（HF）、左心室射血分数（LVEF）降低和重度功能性二尖瓣反流（MR）的患者，经皮缘对缘二尖瓣修复术（PMVR）可能有益。然而，患者选择仍然是一个核心问题。我们旨在探讨在这种情况下，多巴酚丁胺负荷超声心动图（DSE）中基于整体纵向应变（GLS）的左心室收缩储备（LVCR）的潜在作用。
前瞻性纳入 33 名稳定的 HF 患者（MR 分级≥3+；中位 LVEF 为 29%，中位 GLS 为-8.3%），这些患者为 PMVR 的候选者。所有患者均接受 DSE 以评估 LVCR（LVEF 增加≥5%；GLS 增加≥2%；每搏量[SV]增加≥测量 SV 值的 20%）。
DSE 后，21 名患者（64%）检测到阳性 LVCR，12 名患者（36%）检测到阳性 LVCR，14 名患者（42%）检测到阳性 LVCR。在短期随访中，LVCR 与更好的症状缓解、MR 改善和 LV 逆重构相关。DSE 期间 GLS 的显著改善（危险比[HR]，0.549；95%置信区间，0.395-0.765；P<0.001），以及 HF 住院史（HR，1.48；95%置信区间，1.119-1.967；P=0.006）和β受体阻滞剂治疗（HR，0.146；95%置信区间，0.046-0.462；P=0.001），是与死亡/心脏移植/HF 相关住院风险相关的独立因素。
在晚期 HF 中，通过斑点追踪 DSE 评估的 LVCR 与 PMVR 后的更好结果相关。纵向功能的改善超越了射血分数，成为结局的独立预测因素，可改善功能性 MR 经皮矫正的最佳候选者的选择。
