左心房僵硬度可预测射血分数降低的心力衰竭患者的心脏事件：糖尿病的影响。
Left atrial stiffness predicts cardiac events in patients with heart failure and reduced ejection fraction: The impact of diabetes.
机构信息
Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Clinic of Cardiology, University Clinical Centre of Kosovo, and Universi College, Prishtina, Kosovo.
出版信息
Clin Physiol Funct Imaging. 2021 Mar;41(2):208-216. doi: 10.1111/cpf.12688. Epub 2021 Jan 3.
BACKGROUND
The aim of this study was to investigate the relationship between diabetes mellitus (DM) and left atrial (LA) remodelling in a group of patients with heart failure and reduced ejection fraction (HFrEF), and their combined impact on cardiac events (CE).
METHODS
This study included 136 consecutive HFrEF patients (65 ± 11 years), 36 had DM, and 86 had increased LA stiffness (LASt). All patients underwent complete conventional and tissue Doppler echocardiographic measurements were made including LA volumes and function. LASt was calculated using the formula: LASt = E/e' ratio / PALS.
RESULTS
At 55 ± 37 months follow-up, free survival from CE was 69% in patients without DM and 44.4% in those with DM (p < .0001). The CE free survival was lower in patients with increased LASt compared to normal LASt, (50 versus. 80%, p < .001), irrespective of the presence of DM (27 versus. 71%, p < .001).The best cut-off value of LASt for predicting CE in the group as a whole was ≥ 0.82% [81% sensitivity, 72% specificity and AUC 0.82 (p < .001)]. LASt ≥ 0.82% also predicted CE in no DM patients [78% sensitivity, 71% specificity and AUC 0.80 (p < .001)] and was a stronger predictor in DM patients [85% sensitivity, 71% specificity and AUC = 0.847 (p < .001)].
CONCLUSION
High LA stiffness is associated with poor clinical outcome in patients with HFrEF. Diabetes has an additional incremental value in determining clinical outcome in those patients.
背景
本研究旨在探讨心力衰竭射血分数降低（HFrEF）患者中糖尿病（DM）与左心房（LA）重构之间的关系，以及它们对心脏事件（CE）的综合影响。
方法
本研究纳入了 136 例连续的 HFrEF 患者（65±11 岁），其中 36 例患有 DM，86 例 LA 僵硬度增加（LASt）。所有患者均接受了完整的常规和组织多普勒超声心动图测量，包括 LA 容积和功能。LASt 采用公式：LASt=E/e'比值 / PALS 计算。
结果
在 55±37 个月的随访中，无 DM 患者的 CE 无事件生存率为 69%，而有 DM 患者为 44.4%（p<0.0001）。与 LASt 正常的患者相比，LASt 增加的患者 CE 无事件生存率较低（50 与 80%，p<0.001），无论是否存在 DM（27 与 71%，p<0.001）。LASt 预测整体人群 CE 的最佳截断值为≥0.82%[81%敏感性、72%特异性和 AUC 0.82（p<0.001）]。LASt≥0.82%也可预测无 DM 患者的 CE[78%敏感性、71%特异性和 AUC 0.80（p<0.001）]，且在 DM 患者中是更强的预测因素[85%敏感性、71%特异性和 AUC=0.847（p<0.001）]。
结论
LA 僵硬度升高与 HFrEF 患者的不良临床结局相关。在这些患者中，糖尿病具有额外的附加价值来确定临床结局。
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