左心室射血分数改善的心力衰竭患者中整体纵向应变的预后价值
Prognostic Value of Global Longitudinal Strain in Patients With Heart Failure With Improved Ejection Fraction.
作者信息
Janwanishstaporn Satit, Cho Jae Yeong, Feng Siting, Brann Alison, Seo Jeong-Sook, Narezkina Anna, Greenberg Barry
机构信息
Cardiology Department, University of California Medical Center and Sulpizio Cardiovascular Center, La Jolla, California, USA; Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Cardiology Department, University of California Medical Center and Sulpizio Cardiovascular Center, La Jolla, California, USA; Department of Cardiovascular Medicine, Chonnam National University Medical School/Hospital, Gwangju, Korea.
出版信息
JACC Heart Fail. 2022 Jan;10(1):27-37. doi: 10.1016/j.jchf.2021.08.007. Epub 2021 Nov 10.
OBJECTIVES
The authors sought to determine whether global longitudinal strain (GLS) is independently associated with the natural history of patients with heart failure (HF) with improved ejection fraction (HFimpEF).
BACKGROUND
Left ventricular (LV) ejection fraction (EF) often improves in patients with reduced EF. The clinical course of patients with HFimpEF, however, is quite variable. GLS, a sensitive indicator of LV systolic function, could help predict risk of future events in this population.
METHODS
Retrospective analysis of HF patients with LVEF >40% on index echocardiogram who had LVEF <40% on initial study and improvement of ≥10%. GLS was assessed by 2-dimensional speckle-tracking software on index echocardiography. Primary outcome was time to first occurrence of cardiovascular mortality or HF hospitalization/emergency treatment.
RESULTS
Of the 289 patients with HFimpEF, median absolute values of GLS (aGLS) and LVEF from index echocardiography were 12.7% (IQR: 10.8%-14.7%) and 52% (IQR: 46%-58%), respectively. Over 53 months following index echocardiography, the primary endpoint occurred less frequently in patients with aGLS above the median than below it (21% vs 34%; P = 0.014); HR of 0.51; 95% CI: 0.33-0.81; P = 0.004. When assessed as a continuous variable, each 1% increase in aGLS on index echocardiogram was associated with a lower likelihood of the composite endpoint; HR of 0.86; 95% CI: 0.79-0.93; P < 0.001, an association that persisted after multivariable adjustment; HR 0.90; 95% CI: 0.82-0.97; P = 0.01. Lower aGLS was associated with increased likelihood of deterioration in LVEF.
CONCLUSIONS
In patients with HFimpEF, GLS is a strong predictor for future HF events and deterioration in cardiac function.
目的
作者试图确定整体纵向应变（GLS）是否与射血分数改善的心力衰竭（HF）患者（HFimpEF）的自然病史独立相关。
背景
射血分数降低的患者左心室（LV）射血分数（EF）常有所改善。然而，HFimpEF患者的临床病程差异很大。GLS作为LV收缩功能的敏感指标，有助于预测该人群未来事件的风险。
方法
对首次超声心动图检查时LVEF>40%，初始研究时LVEF<40%且改善≥10%的HF患者进行回顾性分析。通过二维斑点追踪软件在首次超声心动图检查时评估GLS。主要结局是首次发生心血管死亡或HF住院/急诊治疗的时间。
结果
在289例HFimpEF患者中，首次超声心动图检查时GLS（aGLS）的中位数绝对值和LVEF分别为12.7%（IQR：10.8%-14.7%）和52%（IQR：46%-58%）。在首次超声心动图检查后的53个月内，aGLS高于中位数的患者发生主要终点事件的频率低于低于中位数的患者（21%对34%；P = 0.014）；风险比为0.51；95%置信区间：0.33-0.81；P = 0.004。当作为连续变量评估时，首次超声心动图检查时aGLS每增加1%，复合终点事件的发生可能性就降低；风险比为0.86；95%置信区间：0.79-0.93；P < 0.001，多变量调整后该关联仍然存在；风险比0.90；95%置信区间：0.82-0.97；P = 0.01。较低的aGLS与LVEF恶化的可能性增加相关。
结论
在HFimpEF患者中，GLS是未来HF事件和心功能恶化的有力预测指标。
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