Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28Post 835, 2900, Copenhagengen, Denmark.
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Int J Cardiovasc Imaging. 2021 Jul;37(7):2207-2215. doi: 10.1007/s10554-021-02202-6. Epub 2021 Mar 10.
The aim of this study was to evaluate layer-specific global longitudinal strain (GLS), obtained by speckle tracking, in predicting outcomes following ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Echocardiography, including layer-specific GLS, was performed at median two days after the STEMI in a prospective study of STEMI patients treated with pPCI between September 2006 and December 2008. The outcome was the composite of heart failure hospitalization and/or cardiovascular death (HF/CVD). A total of 349 patients were included. Mean age was 62.2 ± 11.5 years, 76% were male, and mean ejection fraction (LVEF) was 46 ± 9. Seventy-seven (22%) patients developed HF/CVD during median follow-up 5.4 years. Patients with HF/CVD had lower absolute values for all GLS-layers: endocardial (GLS) 11.4%vs 14.5% (p < 0.001), midmyocardial (GLS) 9.8% vs 12.5% (p < 0.001) and epicardial (GLS) 8.5% vs 10.9% (p < 0.001). In unadjusted analysis, all layers were significant predictors of HF/CVD; hazard ratio (HR) per 1% decrease for GLS: HR 1.18 (95%CI 1.11-1.25), GLS: HR 1.22 (95%CI 1.14-1.30) and GLS: HR 1.26 (95%CI 1.16-1.36), p < 0.0001 for all. The risk of HF/CVD increased incrementally with increasing tertiles for all layers, being more than three times higher in 3rd tertile compared to 1st tertile. In multivariable models, including baseline clinical and echocardiographic parameters, only GLS and GLS remained independent predictors of HF/CVD. Global longitudinal strain obtained from all myocardial layers were significant predictors of incident HF and CVD following STEMI, however, only GLS and GLS remained independent predictors after multivariable adjustment.
本研究旨在评估斑点追踪获得的特定于层的整体纵向应变（GLS）在预测接受直接经皮冠状动脉介入治疗（pPCI）的 ST 段抬高型心肌梗死（STEMI）后的结局。在 2006 年 9 月至 2008 年 12 月期间接受 pPCI 治疗的 STEMI 患者的前瞻性研究中，于 STEMI 后中位两天进行超声心动图检查，包括特定于层的 GLS。该研究的结局是心力衰竭住院和/或心血管死亡（HF/CVD）的复合终点。共纳入 349 例患者。平均年龄为 62.2±11.5 岁，76%为男性，平均射血分数（LVEF）为 46±9。77 例（22%）患者在中位随访 5.4 年内发生 HF/CVD。HF/CVD 患者的所有 GLS 层绝对值均较低：心内膜（GLS）为 11.4%vs 14.5%（p<0.001），中层（GLS）为 9.8%vs 12.5%（p<0.001），心外膜（GLS）为 8.5%vs 10.9%（p<0.001）。在未调整分析中，所有层都是 HF/CVD 的显著预测因子；GLS 每降低 1%的风险比（HR）：HR 1.18（95%CI 1.11-1.25），GLS：HR 1.22（95%CI 1.14-1.30）和 GLS：HR 1.26（95%CI 1.16-1.36），p<0.0001。所有层的 HF/CVD 风险随 tertiles 增加而递增，与 tertiles1 相比， tertiles3 的风险增加超过三倍。在包括基线临床和超声心动图参数的多变量模型中，只有 GLS 和 GLS 仍然是 HF/CVD 的独立预测因子。所有心肌层的整体纵向应变都是 STEMI 后发生 HF 和 CVD 的显著预测因子，但在多变量调整后，只有 GLS 和 GLS 仍然是独立的预测因子。
