转甲状腺素蛋白淀粉样变心肌病患者右心室整体纵向应变的预后价值。
Prognostic value of right ventricular global longitudinal strain in transthyretin amyloid cardiomyopathy.
机构信息
Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto, Japan; Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; Center of Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; Center of Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
出版信息
J Cardiol. 2022 Jul;80(1):56-63. doi: 10.1016/j.jjcc.2022.02.010. Epub 2022 Mar 10.
BACKGROUND
This study was performed to investigate whether right ventricular global longitudinal strain (RV-GLS) provides prognostic information in patients with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM).
METHODS AND RESULTS
Among 129 patients who were diagnosed with ATTRwt-CM at Kumamoto University Hospital from December 2002 to December 2019, 111 patients who had enough information for two-dimensional speckle tracking imaging were retrospectively analyzed. During a median follow-up of 615 days, 26 cardiovascular deaths occurred. Compared with patients in the non-event group, those in the cardiovascular death group were significantly older (81.1 ± 7.4 years vs. 78.2 ± 6.2 years, p = 0.009) and had significantly higher interventricular septal thickness in diastole (16.6 ± 3.1 mm vs. 15.3 ± 2.4 mm, p = 0.048), lower RV-GLS (10.9 ± 2.7% vs. 12.8 ± 3.5%, p = 0.010), and lower right ventricular free wall longitudinal strain (RVFWLS) (13.1 ± 3.3% vs. 15.5 ± 3.8%, p = 0.004). In the univariate Cox proportional hazard analysis, age, left atrial volume index (LAVI), RV-GLS, and RVFWLS were significantly associated with cardiovascular death [age, hazard ratio (HR), 1.10; 95% confidence interval (CI), 1.02-1.19, p = 0.010; LAVI, HR, 1.02; 95% CI, 1.00-1.03, p = 0.009; RV-GLS, HR, 0.86; 95% CI, 0.75-0.97, p = 0.017; RVFWLS, HR 0.89; 95% CI, 0.79-1.00; p = 0.041]. Multivariable Cox proportional hazard analysis showed RV-GLS was significantly and independently associated with cardiovascular death in patients with ATTRwt-CM (HR, 0.86; 95% CI, 0.74-0.99; p = 0.038). Receiver operating characteristic analysis showed that the area under the curve of RV-GLS for cardiovascular death was 0.668 and that the best cut-off value of RV-GLS was 11.59% (sensitivity, 69.2%; specificity, 63.5%). In the Kaplan-Meier analysis, patients with ATTRwt-CM who had low RV-GLS (<11.59%) had a significantly higher probability of total cardiovascular death (p = 0.004) and heart failure-related hospitalization (p = 0.013).
CONCLUSION
RV-GLS has significant prognostic value in patients with ATTRwt-CM and provides greater prognostic power than conventional echocardiographic findings.
背景
本研究旨在探讨右心室整体纵向应变（RV-GLS）能否为野生型转甲状腺素蛋白淀粉样变心肌病（ATTRwt-CM）患者提供预后信息。
方法和结果
在 2002 年 12 月至 2019 年 12 月期间，于熊本大学医院诊断为 ATTRwt-CM 的 129 例患者中，回顾性分析了 111 例有足够二维斑点追踪成像信息的患者。在中位随访 615 天期间，发生了 26 例心血管死亡。与非事件组相比，心血管死亡组患者年龄明显更大（81.1±7.4 岁 vs. 78.2±6.2 岁，p=0.009），舒张期室间隔厚度明显更高（16.6±3.1 毫米 vs. 15.3±2.4 毫米，p=0.048），RV-GLS 明显更低（10.9±2.7% vs. 12.8±3.5%，p=0.010），右心室游离壁纵向应变（RVFWLS）明显更低（13.1±3.3% vs. 15.5±3.8%，p=0.004）。单因素 Cox 比例风险分析显示，年龄、左心房容积指数（LAVI）、RV-GLS 和 RVFWLS 与心血管死亡显著相关[年龄，风险比（HR），1.10；95%置信区间（CI），1.02-1.19，p=0.010；LAVI，HR，1.02；95%CI，1.00-1.03，p=0.009；RV-GLS，HR，0.86；95%CI，0.75-0.97，p=0.017；RVFWLS，HR 0.89；95%CI，0.79-1.00；p=0.041]。多变量 Cox 比例风险分析显示，RV-GLS 与 ATTRwt-CM 患者的心血管死亡显著相关（HR，0.86；95%CI，0.74-0.99；p=0.038）。受试者工作特征曲线分析显示，RV-GLS 预测心血管死亡的曲线下面积为 0.668，最佳 RV-GLS 截断值为 11.59%（灵敏度，69.2%；特异性，63.5%）。在 Kaplan-Meier 分析中，RV-GLS 较低（<11.59%）的 ATTRwt-CM 患者总心血管死亡的概率显著更高（p=0.004）和心力衰竭相关住院的概率显著更高（p=0.013）。
结论
RV-GLS 在 ATTRwt-CM 患者中有显著的预后价值，比传统超声心动图检查结果提供更大的预后能力。
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