系统性右心室心肌变形：应变成像改善衰竭心脏的预测。
Myocardial Deformation in the Systemic Right Ventricle: Strain Imaging Improves Prediction of the Failing Heart.
机构信息
Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands; Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands.
出版信息
Can J Cardiol. 2020 Sep;36(9):1525-1533. doi: 10.1016/j.cjca.2019.12.014. Epub 2019 Dec 17.
BACKGROUND
Predicting heart failure events in patients with a systemic right ventricle (sRV) due to transposition of the great arteries (TGA) is important for timely intensification of follow-up. This study assessed the value of strain compared with currently used parameters as predictor for heart failure-free survival in patients with sRV.
METHODS
In participants of a multicentre trial, speckle-tracking echocardiography (STE) was performed to assess global longitudinal strain (GLS), mechanical dispersion (MD), and postsystolic shortening (PSS). Cox regression was used to determine the association of STE parameters with the combined end point of progression of heart failure and death, compared with cardiovascular magnetic resonance (CMR) and computed tomography (CT) derived parameters.
RESULTS
Echocardiograms of 60 patients were analyzed (mean age 34 ± 11 years, 65% male, 35% congenitally corrected TGA). Mean GLS was -13.5 ± 2.9%, median MD was 49 (interquartile range [IQR] 30-76) ms, and 14 patients (23%) had PSS. During a median 8 (IQR 7-9) years, 15 patients (25%) met the end point. GLS, MD, and PSS were all associated with heart failure-free survival in univariable analysis. After correction for age, only GLS (optimal cutoff > -10.5%) and CMR/CT-derived sRV ejection fraction (optimal cutoff < 30%) remained associated with heart failure-free survival: hazard ratio (HR) 8.27, 95% confidence interval (CI) 2.50-27.41 (P < 0.001), and HR 4.34, 95% CI 1.48-12.74 (P = 0.007), respectively). Combining GLS and ejection fraction improved prediction, with patients with both GLS > -10.5% and sRV ejection fraction < 30% at highest risk (HR 19.69, 95% CI 4.90-79.13; P < 0.001).
CONCLUSIONS
The predictive value of GLS was similar to that of CMR/CT-derived ejection fraction. The combination of GLS and ejection fraction identified patients at highest risk of heart failure and death. Easily available STE parameters can be used to guide follow-up intensity and can be integrated into future risk prediction scores.
背景
对于大动脉转位（TGA）导致的系统性右心室（sRV）患者，预测心力衰竭事件对于及时加强随访非常重要。本研究评估了应变与目前使用的参数相比作为 sRV 患者心力衰竭无事件生存预测因子的价值。
方法
在一项多中心试验的参与者中，使用斑点追踪超声心动图（STE）评估整体纵向应变（GLS）、机械弥散（MD）和收缩后缩短（PSS）。使用 Cox 回归来确定 STE 参数与心力衰竭进展和死亡的联合终点之间的关联，与心血管磁共振（CMR）和计算机断层扫描（CT）得出的参数进行比较。
结果
对 60 例患者的超声心动图进行了分析（平均年龄 34 ± 11 岁，65%为男性，35%为先天性矫正 TGA）。平均 GLS 为-13.5 ± 2.9%，中位数 MD 为 49（四分位距[IQR]30-76）ms，14 例（23%）患者存在 PSS。在中位 8（IQR 7-9）年期间，15 例（25%）患者达到了终点。在单变量分析中，GLS、MD 和 PSS 均与心力衰竭无事件生存率相关。校正年龄后，仅 GLS（> -10.5%的最佳截断值）和 CMR/CT 得出的 sRV 射血分数（< 30%的最佳截断值）与心力衰竭无事件生存率相关：风险比（HR）8.27，95%置信区间（CI）2.50-27.41（P < 0.001）和 HR 4.34，95%CI 1.48-12.74（P = 0.007）。联合 GLS 和射血分数可改善预测，GLS > -10.5%且 sRV 射血分数< 30%的患者风险最高（HR 19.69，95%CI 4.90-79.13；P < 0.001）。
结论
GLS 的预测价值与 CMR/CT 得出的射血分数相似。GLS 和射血分数的联合可识别心力衰竭和死亡风险最高的患者。易于获得的 STE 参数可用于指导随访强度，并可整合到未来的风险预测评分中。
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