Chang Wei-Ting, Lin Chih Hsien, Hong Chon-Seng, Liao Chia-Te, Liu Yen-Wen, Chen Zhih-Cherng, Shih Jhih-Yuan
Department of Cardiology, Chi Mei Medical Center, Tainan, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
Department of Cardiology, Chi Mei Medical Center, Tainan, Taiwan.
J Cardiol. 2021 May;77(5):509-516. doi: 10.1016/j.jjcc.2020.10.018. Epub 2020 Nov 21.
Heart failure (HF) with mid-range ejection fraction (HFmrEF) is defined as HF with a left ventricular (LV) ejection fraction (LVEF) of 41-49%. However, the change in LV function and the subsequent prognosis in these patients remain unclear. We aimed to investigate whether LV global longitudinal strain (LV GLS) could differentiate the changes in LVEF and predict the clinical outcomes in patients with HFmrEF.
According to the changes in LVEF on follow-up echocardiography, 273 outpatients with HFmrEF were divided into 3 groups: HFwEF (HF with worse EF: <40%), HFsEF (HF with similar EF: 40-49%), and HFrecEF (HF with recovered EF: >50%). Further, the LV GLS at diagnosis was evaluated.
The average follow-up duration was 31 months. Among patients with HFmrEF, the more impaired the LV GLS at baseline, the higher probability of HFwEF development. In comparison with patients with HFwEF and HFsEF, those with HFrecEF had a lower risk of hospitalization for HF. At a cut-off value of -11%, LV GLS differentiated the subsequent risk of cardiovascular death in patients with HFmrEF. In Cox regression, patients with LV GLS >-11% had a high risk of cardiovascular death.
In patients with HFmrEF, LV GLS is associated with LVEF changes and subsequent cardiovascular death. Patients with HFrecEF had a lower risk of hospitalization for HF.
射血分数处于中间范围的心衰（HFmrEF）定义为左心室（LV）射血分数（LVEF）为41%-49%的心衰。然而，这些患者左心室功能的变化及随后的预后仍不清楚。我们旨在研究左心室整体纵向应变（LV GLS）是否能够区分LVEF的变化并预测HFmrEF患者的临床结局。
根据随访超声心动图检查中LVEF的变化，将273例HFmrEF门诊患者分为3组：HFwEF（射血分数恶化的心衰：<40%）、HFsEF（射血分数相似的心衰：40%-49%）和HFrecEF（射血分数恢复的心衰：>50%）。此外，评估诊断时的LV GLS。
平均随访时间为31个月。在HFmrEF患者中，基线时LV GLS受损越严重，发生HFwEF的可能性越高。与HFwEF和HFsEF患者相比，HFrecEF患者因心衰住院的风险较低。LV GLS以-11%为临界值时，可区分HFmrEF患者随后发生心血管死亡的风险。在Cox回归分析中，LV GLS > -11%的患者发生心血管死亡的风险较高。
在HFmrEF患者中，LV GLS与LVEF变化及随后的心血管死亡相关。HFrecEF患者因心衰住院的风险较低。
