整体纵向应变在鉴别左心室肥厚的变异形式和预测死亡率中的作用。
Role of global longitudinal strain in discriminating variant forms of left ventricular hypertrophy and predicting mortality.
机构信息
Department of Cardiology, İstanbul Medical Faculty, İstanbul University; İstanbul-Turkey.
Department of Cardiology, Manavgat State Hospital; Antalya-Turkey.
出版信息
Anatol J Cardiol. 2021 Dec;25(12):863-871. doi: 10.5152/AnatolJCardiol.2021.21940.
OBJECTIVE
In this study, we aimed to compare the functional adaptations of the left ventricle in variant forms of left ventricular hypertrophy (LVH) and to evaluate the use of two-dimensional speckle tracking echocardiography (2D-STE) in differential diagnosis and prognosis.
METHODS
This was a prospective cohort study of 68 patients with LVH, including 20 patients with non-obstructive hypertrophic cardiomyopathy (HCM), 23 competitive top-level athletes free of cardiovascular disease, and 25 patients with hypertensive heart disease (HHD). All the subjects underwent 2D transthoracic echocardiography (TTE) and 2D-STE. The primary endpoint was all-cause mortality. Global longitudinal strain (GLS) below -12.5% was defined as severely reduced strain, -12.5% to -17.9% as mildly reduced strain, and above -18% as normal strain.
RESULTS
The mean LV-GLS value was higher in athletes than in patients with HCM and HHD with the lowest value being in the HCM group (HCM: -11.4±2.2%; HHD: -13.6±2.6%; and athletes: -15.5±2.1%; p<0.001 among groups). LV-GLS below -12.5% distinguished HCM from others with 65% sensitivity and 77% specificity [area under curve (AUC)=0.808, 95% confidence interval (CI): 0.699-0.917, p<0.001]. The median follow-up duration was 6.4±1.1 years. Overall, 11 patients (16%) died. Seven of these were in the HHD group, and four were in the HCM group. The mean GLS value in patients who died was -11.8±1.5%. LV-GLS was significantly associated with mortality after adjusting age and sex via multiple analysis (RR=0.723, 95% CI: 0.537-0.974, p=0.033). Patients with GLS below -12.5% had a higher risk of all-cause mortality compared with that of patients with GLS above -12.5% according to Kaplan-Meier survival analysis for 7 years (29% vs. 9%; p=0.032). The LV-GLS value predicts mortality with 64% sensitivity and 70% specificity with a cut-off value of -12.5 (AUC=0.740, 95% CI: 0.617-0.863, p=0.012).
CONCLUSION
The 2D-STE provides important information about the longitudinal systolic function of the myocardium. It may enable differentiation variable forms of LVH and predict prognosis.
目的
本研究旨在比较左心室不同形式肥厚（LVH）的功能适应性，并评估二维斑点追踪超声心动图（2D-STE）在鉴别诊断和预后中的应用。
方法
这是一项前瞻性队列研究，纳入 68 例 LVH 患者，包括 20 例非梗阻性肥厚型心肌病（HCM）患者、23 名无心血管疾病的竞技性顶级运动员和 25 名高血压性心脏病（HHD）患者。所有患者均接受二维经胸超声心动图（TTE）和二维斑点追踪超声心动图（2D-STE）检查。主要终点为全因死亡率。将整体纵向应变（GLS）值低于-12.5%定义为严重应变降低，-12.5%至-17.9%定义为轻度应变降低，高于-18%定义为正常应变。
结果
运动员的平均 LV-GLS 值高于 HCM 患者和 HHD 患者，HCM 患者的最低值（HCM：-11.4±2.2%；HHD：-13.6±2.6%；运动员：-15.5±2.1%；组间比较 p<0.001）。LV-GLS 值低于-12.5%可区分 HCM 与其他类型，其灵敏度为 65%，特异性为 77%[曲线下面积（AUC）=0.808，95%置信区间（CI）：0.699-0.917，p<0.001]。中位随访时间为 6.4±1.1 年。总体而言，11 名患者（16%）死亡。其中 7 例来自 HHD 组，4 例来自 HCM 组。死亡患者的平均 GLS 值为-11.8±1.5%。多因素分析显示，GLS 值与死亡率显著相关（RR=0.723，95%CI：0.537-0.974，p=0.033）。Kaplan-Meier 生存分析显示，GLS 值低于-12.5%的患者在 7 年的随访中全因死亡率明显高于 GLS 值高于-12.5%的患者（29%比 9%；p=0.032）。GLS 值的截断值为-12.5%时，预测死亡率的敏感性为 64%，特异性为 70%，曲线下面积为 0.740（95%CI：0.617-0.863，p=0.012）。
结论
2D-STE 提供了有关心肌纵向收缩功能的重要信息。它可以区分左心室不同形式的肥厚，并预测预后。
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