Brainin Philip, Lindberg Søren, Olsen Flemming J, Pedersen Sune, Iversen Allan, Galatius Søren, Fritz-Hansen Thomas, Gislason Gunnar, Søgaard Peter, Møgelvang Rasmus, Biering-Sørensen Tor
Department of Cardiology, Federal University of Acre, Acre, Brazil.
Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark.
Int J Cardiol Heart Vasc. 2021 May 28;34:100799. doi: 10.1016/j.ijcha.2021.100799. eCollection 2021 Jun.
Early systolic lengthening (ESL), a paradoxical stretch of myocardial fibers, has been linked to loss of myocardial viability and contractile dysfunction. We assessed the long-term prognostic potential of ESL in coronary artery bypass graft (CABG) patients.
We retrospectively included patients (n = 709; mean age 68 years; 85% men) who underwent speckle tracking echocardiography (median 15 days) prior to CABG. Endpoints were cardiovascular death (CVD) and all-cause mortality. We assessed amplitude of ESL (%), defined as peak positive strain, and duration of ESL (ms), determined as time from Q-wave on the ECG to peak positive strain. We applied Cox models adjusted for clinical risk assessed as EuroSCORE II.
During median follow-up of 3.8 years [IQR 2.7-4.9 years], 45 (6%) experienced CVD and 80 (11%) died. In survival analyses adjusted for EuroSCORE II, each 1% increase in amplitude of ESL was associated with CVD (HR 1.35 [95%CI 1.09-1.68], P = 0.006) and all-cause mortality (HR 1.29 [95%CI 1.08-1.54], P = 0.004). Similar findings applied to duration of ESL (per 10ms increase) and CVD (HR 1.12 [95%CI 1.02-1.23], P = 0.016) and all-cause mortality (HR 1.09 [95%CI 1.01--1.17], P = 0.031). The prognostic value of ESL amplitude was modified by sex (P interaction < 0.05), such that the prognostic value was greater in women for both endpoints. When adding ESL duration to EuroSCORE II, the net reclassification index improved significantly for both CVD and all-cause mortality.
Assessment of ESL provides independent and incremental prognostic information in addition to the EuroSCORE II for CVD and all-cause mortality in CABG patients.
早期收缩期延长（ESL），即心肌纤维的反常伸展，与心肌活力丧失和收缩功能障碍有关。我们评估了ESL对冠状动脉旁路移植术（CABG）患者的长期预后潜力。
我们回顾性纳入了在CABG术前接受斑点追踪超声心动图检查（中位时间为15天）的患者（n = 709；平均年龄68岁；85%为男性）。终点为心血管死亡（CVD）和全因死亡率。我们评估了ESL的幅度（%），定义为峰值正应变，以及ESL的持续时间（ms），确定为从心电图上的Q波到峰值正应变的时间。我们应用了根据欧洲心脏手术风险评估系统II（EuroSCORE II）评估的临床风险进行调整的Cox模型。
在中位随访3.8年[四分位间距2.7 - 4.9年]期间，45例（6%）发生CVD，80例（11%）死亡。在根据EuroSCORE II进行调整的生存分析中，ESL幅度每增加1%与CVD（风险比[HR] 1.35 [95%置信区间1.09 - 1.68]，P = 0.006）和全因死亡率（HR 1.29 [95%置信区间1.08 - 1.54]，P = 0.004）相关。类似的结果适用于ESL持续时间（每增加10ms）与CVD（HR 1.12 [95%置信区间1.02 - 1.23]，P = 0.016）和全因死亡率（HR 1.09 [95%置信区间1.01 - 1.17]，P = 0.031）。ESL幅度的预后价值因性别而改变（P交互作用<0.05），即对于两个终点，女性的预后价值更大。当将ESL持续时间添加到EuroSCORE II中时，CVD和全因死亡率的净重新分类指数均显著改善。
除了EuroSCORE II外，ESL评估为CABG患者的CVD和全因死亡率提供了独立且增量的预后信息。
