左心室整体纵向应变在中度主动脉瓣狭窄患者中的变化。
Left Ventricular Global Longitudinal Strain in Patients with Moderate Aortic Stenosis.
机构信息
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Jessa Hospital, Hasselt, Belgium.
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
出版信息
J Am Soc Echocardiogr. 2022 Aug;35(8):791-800.e4. doi: 10.1016/j.echo.2022.03.008. Epub 2022 Mar 15.
UNLABELLED
Moderate aortic stenosis (AS) is associated with an increased risk for adverse events. Although reduced left ventricular (LV) global longitudinal strain (GLS) is associated with worse outcomes in patients with severe AS, its prognostic value in patients with moderate AS is unknown. The aim of this study was to investigate the prognostic implications of LV GLS in patients with moderate AS.
METHODS
LV GLS was evaluated using speckle-tracking echocardiography in patients with moderate AS (aortic valve area 1.0-1.5 cm) and reported as absolute (i.e., positive) values. Patients were divided into three groups: LV ejection fraction (LVEF) < 50% (group 1), LVEF ≥ 50% but LV GLS < 16% (group 2), and LVEF ≥ 50% and LV GLS ≥ 16% (group 3). The LV GLS value of 16% was based on spline curve analysis. The primary end point was all-cause mortality.
RESULTS
A total of 760 patients (mean age, 71 ± 12 years; 61% men) were analyzed. During a median follow-up period of 50 months (interquartile range, 26-94 months), 257 patients (34%) died. Patients with LVEF < 50% and LVEF ≥ 50% but LV GLS < 16% showed significantly higher mortality rates at 1-, 3-, and 5-year follow-up (82%, 71%, and 58%; and 92%, 77%, and 58%, respectively) compared with those with LVEF ≥ 50% and LV GLS ≥ 16% (96%, 91%, and 85%, respectively; P < .001). Long-term outcomes were not different between patients with LVEF < 50% and those with LVEF ≥ 50% but LV GLS < 16% (P = .592). LV GLS discriminated higher risk patients even among those with LVEF ≥ 60% (P < .001) or those who were asymptomatic (P < .001). On multivariable analysis, LVEF < 50% (hazard ratio, 2.384; 95% CI, 1.614-3.522; P < .001) and LVEF ≥ 50% but LV GLS < 16% (hazard ratio, 2.467; 95% CI, 1.802-3.378; P < .001) were independently associated with all-cause mortality.
CONCLUSIONS
In patients with moderate AS, reduced LV GLS is associated with an increased risk for all-cause mortality, even if LVEF is still preserved.
背景
中度主动脉瓣狭窄（AS）与不良事件风险增加相关。虽然左心室（LV）整体纵向应变（GLS）降低与严重 AS 患者的预后较差相关，但在中度 AS 患者中的预后价值尚不清楚。本研究旨在探讨 LV GLS 在中度 AS 患者中的预后意义。
方法
采用斑点追踪超声心动图评估中度 AS 患者（主动脉瓣面积 1.0-1.5 cm）的 LV GLS，并以绝对值（即阳性）表示。患者被分为三组：LVEF < 50%（组 1）、LVEF ≥ 50%但 LV GLS < 16%（组 2）和 LVEF ≥ 50%且 LV GLS ≥ 16%（组 3）。16%的 LV GLS 值基于样条曲线分析。主要终点是全因死亡率。
结果
共分析了 760 例患者（平均年龄 71 ± 12 岁；61%为男性）。在中位随访 50 个月（四分位距 26-94 个月）期间，257 例患者（34%）死亡。LVEF < 50%和 LVEF ≥ 50%但 LV GLS < 16%的患者在 1 年、3 年和 5 年随访时的死亡率明显更高（分别为 82%、71%和 58%；和 92%、77%和 58%；P <.001），与 LVEF ≥ 50%且 LV GLS ≥ 16%的患者相比（分别为 96%、91%和 85%；P <.001）。LVEF < 50%的患者与 LVEF ≥ 50%但 LV GLS < 16%的患者之间的长期预后无差异（P =.592）。LV GLS 甚至在 LVEF ≥ 60%的患者（P <.001）或无症状患者（P <.001）中也能区分出高危患者。多变量分析显示，LVEF < 50%（风险比，2.384；95%CI，1.614-3.522；P <.001）和 LVEF ≥ 50%但 LV GLS < 16%（风险比，2.467；95%CI，1.802-3.378；P <.001）与全因死亡率独立相关。
结论
在中度 AS 患者中，LV GLS 降低与全因死亡率增加相关，即使 LVEF 仍然保留。
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