左心室整体纵向应变与中度主动脉瓣狭窄的长期预后相关。

Left Ventricular Global Longitudinal Strain Is Associated With Long-Term Outcomes in Moderate Aortic Stenosis.

机构信息

Department of Cardiovascular Medicine (D.Z., S.I., W.R.M., V.T.N., S.V.P., H.R.V., P.A.P., J.K.O.), Mayo Clinic, Rochester, MN.

Department of Cardiology, Peking University Third Hospital, NHFPC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, China (D.Z.).

出版信息

Circ Cardiovasc Imaging. 2020 Apr;13(4):e009958. doi: 10.1161/CIRCIMAGING.119.009958. Epub 2020 Apr 9.

DOI:10.1161/CIRCIMAGING.119.009958

PMID:32268808

Abstract

BACKGROUND

Left ventricular global longitudinal strain (GLS) is associated with long-term outcomes of patients with severe aortic stenosis. However, its prognostic value in patients with moderate aortic stenosis remains unknown.

METHODS

Patients diagnosed with moderate aortic stenosis (1.0< aortic valve area ≤1.5 cm) and left ventricular ejection fraction ≥50% were identified. GLS was assessed by 2-dimensional strain imaging using speckle-tracking method. All-cause mortality was assessed according to the median GLS value.

RESULTS

Two hundred eighty-seven patients were included (median age 76 years; 47% male). Mean aortic valve area was 1.25 cm, left ventricular ejection fraction 62%, and median GLS -15.2%. During a median follow-up of 3.9 years, there were 103 deaths (36%). Mortality was higher in patients with GLS>-15.2% (hazard ratio 2.62 [95% CI 1.69-4.06]) compared with patients with GLS ≤-15.2% even after adjusting for confounders. Mortality rates at 1, 3, 5 years were 21%, 35%, 48%, respectively, in patients with GLS >-15.2%, and 6%, 15%, 19% in those with GLS ≤-15.2%. Even among those with left ventricular ejection fraction ≥60%, GLS discriminated higher-risk patients (=0.0003). During follow-up, 106 (37%) patients underwent aortic valve replacement with median waiting-time of 2.4 years, and their survival was better than patients without aortic valve replacement. Among those patients undergoing aortic valve replacement, prognosis was still worse in patients with GLS >-15.2% (=0.04). Mortality rates at 1, 3, 5 years were 2%, 10%, 20%, respectively, in patients with GLS >-15.2% and 2%, 5%, 6% in those with GLS ≤-15.2%.

CONCLUSIONS

Impaired GLS in moderate aortic stenosis patients is associated with higher mortality rates even among those undergoing aortic valve replacement.

摘要

背景

左心室整体纵向应变（GLS）与严重主动脉瓣狭窄患者的长期预后相关。然而，其在中度主动脉瓣狭窄患者中的预后价值尚不清楚。

方法

确定诊断为中度主动脉瓣狭窄（1.0<aortic valve area ≤1.5 cm）且左心室射血分数≥50%的患者。使用斑点追踪法通过二维应变成像评估 GLS。根据 GLS 的中位数评估全因死亡率。

结果

共纳入 287 例患者（中位年龄 76 岁，47%为男性）。平均主动脉瓣口面积为 1.25 cm，左心室射血分数为 62%，中位数 GLS 为-15.2%。中位随访 3.9 年后，有 103 例死亡（36%）。与 GLS ≤-15.2%的患者相比，GLS＞-15.2%的患者死亡率更高（危险比 2.62[95%CI 1.69-4.06]），即使在校正混杂因素后也是如此。GLS＞-15.2%的患者 1 年、3 年、5 年的死亡率分别为 21%、35%、48%，而 GLS ≤-15.2%的患者分别为 6%、15%、19%。即使在左心室射血分数≥60%的患者中，GLS 也能区分出高风险患者（=0.0003）。随访期间，有 106 例（37%）患者接受了主动脉瓣置换术，中位等待时间为 2.4 年，他们的生存情况好于未行主动脉瓣置换术的患者。在接受主动脉瓣置换术的患者中，GLS＞-15.2%的患者预后仍较差（=0.04）。GLS＞-15.2%的患者 1 年、3 年、5 年的死亡率分别为 2%、10%、20%，而 GLS ≤-15.2%的患者分别为 2%、5%、6%。