Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
JACC Cardiovasc Imaging. 2021 Jul;14(7):1324-1334. doi: 10.1016/j.jcmg.2021.01.020. Epub 2021 Mar 17.
The aims of this study were to characterize the interplay between mixed aortic valve disease (MAVD) phenotypes (defined by concomitant severities of aortic stenosis and aortic regurgitation) and left ventricular global longitudinal strain (LV-GLS), and to assess the prognostic utility of LV-GLS in MAVD.
Little is known about the way LV-GLS separates MAVD phenotypes and if it is associated with their outcomes.
This observational cohort study evaluated 783 consecutive adult patients with left ventricular ejection fraction ≥50% and MAVD, which was defined as coexisting with at least moderate aortic stenosis and at least moderate aortic regurgitation. We measured the conventional echocardiographic variables and average LV-GLS from apical long, 2- and 4-chamber views. The primary endpoint was all-cause mortality.
Mean age of patients was 69 ± 15 years, and 58% were male. Mean LV-GLS was -14.7 ± 2.9%. In total, 458 patients (59%) underwent aortic valve replacement at a median period of 50 days (25th to 75th percentile range: 6 to 560 days). During a median follow-up period of 5.6 years (25th to 75th percentile range: 1.8 to 9.4 years), 391 patients (50%) died. When stratified patients into tertiles according to LV-GLS values, patients with worse LV-GLS had worse outcomes (p < 0.001). LV-GLS was independently associated with mortality (hazard ratio: 1.09; 95% confidential intervals: 1.04 to 1.14; p < 0.001), with the relationship between LV-GLS and mortality being linear.
LV-GLS is associated with all-cause mortality. LV-GLS may be useful for risk stratification in patients with MAVD.
本研究旨在探讨混合性主动脉瓣疾病（MAVD）表型（由主动脉瓣狭窄和主动脉瓣反流的严重程度共同定义）与左心室整体纵向应变（LV-GLS）之间的相互作用，并评估 LV-GLS 在 MAVD 中的预后价值。
对于 LV-GLS 如何区分 MAVD 表型以及它是否与这些表型的结局相关，我们知之甚少。
本观察性队列研究纳入了 783 例左心室射血分数≥50%且伴有 MAVD 的成年患者，MAVD 定义为同时存在至少中度主动脉瓣狭窄和至少中度主动脉瓣反流。我们从心尖长轴、2 腔和 4 腔切面测量了传统的超声心动图变量和平均 LV-GLS。主要终点是全因死亡率。
患者的平均年龄为 69±15 岁，58%为男性。平均 LV-GLS 为-14.7±2.9%。共有 458 例（59%）患者在中位时间为 50 天（25%至 75%分位范围：6 至 560 天）内行主动脉瓣置换术。在中位随访 5.6 年（25%至 75%分位范围：1.8 至 9.4 年）期间，391 例（50%）患者死亡。当根据 LV-GLS 值将患者分为三分位时，LV-GLS 值较差的患者预后较差（p<0.001）。LV-GLS 与死亡率独立相关（危险比：1.09；95%置信区间：1.04 至 1.14；p<0.001），LV-GLS 与死亡率之间呈线性关系。
LV-GLS 与全因死亡率相关。LV-GLS 可能对 MAVD 患者的风险分层有用。
