左心房应变与心力衰竭接受最佳治疗患者的功能恢复相关。

Left Atrial Strain Associated with Functional Recovery in Patients Receiving Optimal Treatment for Heart Failure.

机构信息

Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan.

Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan.

出版信息

J Am Soc Echocardiogr. 2021 Sep;34(9):966-975.e2. doi: 10.1016/j.echo.2021.03.016. Epub 2021 Apr 20.

DOI:10.1016/j.echo.2021.03.016

PMID:33852960

Abstract

BACKGROUND

Heart failure with recovered ejection fraction (HFrecEF) has been reported in several previous studies to have a better prognosis than heart failure with reduced ejection fraction (HFrEF). However, the factors associated with HFrecEF have not been identified. The aim of this study was to test the hypothesis that left atrial (LA) strain could help identify patients with recovered ejection fraction (EF) among those with heart failure (HF) with low EF on admission.

METHODS

One hundred consecutive patients hospitalized for the first time for new-onset HF were enrolled. Patients were clinically diagnosed with HFrEF on admission (left ventricular EF < 40%) and received optimal treatment for HF. Twenty-eight patients improved to HFrecEF during 6 months of follow-up.

RESULTS

Regarding clinical background, there were significantly more women and a lower rate of atrial fibrillation in the HFrecEF group than in the HFrEF group. In a multivariate logistic regression analysis, LA strain was an independent predictor of HFrecEF, even after adjustment for gender and left ventricular EF (odds ratio: 4.06; 95% CI: 2.04-8.07; P < .001). A cutoff value of 10.8% for LA strain showed high sensitivity (96%) and specificity (82%) in identifying HFrecEF in patients with HF presenting with low EF on admission. During a follow-up period of 24 ± 13 months, 31 patients (31%) had cardiovascular death or readmission for HF. Patients with reduced LA strain (<10.8%) had significantly shorter event-free survival than those with preserved LA strain (P = .02).

CONCLUSIONS

LA strain is a useful indicator for predicting HFrecEF and should be considered as a routine measurement in patients with HFrEF on admission.

摘要

背景

几项先前的研究报告称，射血分数恢复的心衰（HFrecEF）的预后优于射血分数降低的心衰（HFrEF）。然而，与 HFrecEF 相关的因素尚未确定。本研究旨在检验以下假设，即在入院时射血分数较低的心力衰竭（HF）患者中，左心房（LA）应变可帮助识别射血分数恢复的患者。

方法

连续纳入 100 例首次因新发 HF 住院的患者。入院时临床诊断为 HFrEF（左心室 EF<40%），并接受 HF 的最佳治疗。28 例患者在 6 个月的随访中改善为 HFrecEF。

结果

在临床背景方面，HFrecEF 组的女性明显更多，心房颤动发生率更低。在多变量逻辑回归分析中，LA 应变是 HFrecEF 的独立预测因素，即使在校正性别和左心室 EF 后也是如此（优势比：4.06；95%置信区间：2.04-8.07；P<0.001）。LA 应变的截断值为 10.8%，可在入院时 EF 较低的 HF 患者中以 96%的高灵敏度和 82%的高特异性识别 HFrecEF。在 24±13 个月的随访期间，31 例患者（31%）发生心血管死亡或因 HF 再次入院。LA 应变降低（<10.8%）的患者无事件生存时间明显短于 LA 应变保留的患者（P=0.02）。