通过增加整体纵向应变来改善 A 期和 B 期心力衰竭的特征。
Improving the Characterization of Stage A and B Heart Failure by Adding Global Longitudinal Strain.
机构信息
Baker Heart and Diabetes Institute, Melbourne, Australia; Cardiology Department, Western Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia.
Baker Heart and Diabetes Institute, Melbourne, Australia.
出版信息
JACC Cardiovasc Imaging. 2022 Aug;15(8):1380-1387. doi: 10.1016/j.jcmg.2022.03.007. Epub 2022 May 11.
BACKGROUND
Current guidelines distinguish stage B heart failure (SBHF) (asymptomatic left ventricular [LV] dysfunction) from stage A heart failure (SAHF) (asymptomatic with heart failure [HF] risk factors) on the basis of myocardial infarction, LV remodeling (hypertrophy or reduced ejection fraction [EF]) or valvular disease. However, subclinical HF with preserved EF may not be identified with these criteria.
OBJECTIVES
The purpose of this study was to assess the prediction of incident HF with global longitudinal strain (GLS) in patients with SAHF and SBHF.
METHODS
The authors analyzed echocardiograms (including GLS) in 447 patients (age 65 ± 11 years; 77% male) enrolled in a prospective study of HF in individuals at risk of incident HF, with normal or mildly impaired EF (≥40%). Long-term follow-up was obtained via data linkage. Analysis was performed using a competing risks model.
RESULTS
After a median of 9 years of follow-up, 50 (10%) of the 447 patients had new HF admissions, and 87 (18%) died. In multivariable analysis, all imaging variables were independent predictors of HF admissions, including left ventricular ejection fraction (LVEF) (HR: 0.97 [95% CI: 0.94-0.99]), LV mass index (HR: 1.01 [95% CI: 1.00-1.02]), left atrial volume index (HR: 1.02 [95% CI: 1.00-1.05]), and E/e' (HR: 1.05 [95% CI: 1.01-1.24]), incremental to clinical variables (age and Charlson comorbidity score). However, the addition of GLS provided value incremental to both clinical and other echocardiographic parameters (P = 0.004). Impaired GLS (<18%) (HR: 4.09 [95% CI: 1.87-8.92]) was independent and incremental to all clinical and other echocardiographic variables in predicting HF, and impaired LVEF, left ventricular hypertrophy, left atrial enlargement, high E/e', or SBHF were not predictive.
CONCLUSIONS
The inclusion of GLS as a criterion for SBHF would add independent and incremental information to standard markers of SBHF for the prediction of subsequent HF admissions.
背景
目前的指南基于心肌梗死、左心室重构（肥厚或射血分数降低）或瓣膜疾病，将心力衰竭（HF）B 期（无症状左心室功能障碍）与心力衰竭（HF）A 期（无症状但有 HF 风险因素）区分开来。然而，这些标准可能无法识别无症状、射血分数保留的 HF。
目的
本研究旨在评估整体纵向应变（GLS）在心力衰竭 A 期（SAHF）和心力衰竭 B 期（SBHF）患者中对 HF 事件的预测作用。
方法
作者分析了 447 例患者的超声心动图（包括 GLS），这些患者年龄为 65±11 岁，77%为男性，他们参加了一项 HF 风险个体 HF 前瞻性研究，EF 值正常或轻度受损（≥40%）。通过数据链接获得长期随访。使用竞争风险模型进行分析。
结果
中位随访 9 年后，447 例患者中有 50 例（10%）发生新的 HF 入院，87 例（18%）死亡。多变量分析中，所有影像学变量均为 HF 入院的独立预测因子，包括左心室射血分数（LVEF）（HR：0.97[95%CI：0.94-0.99]）、左心室质量指数（LVMI）（HR：1.01[95%CI：1.00-1.02]）、左心房容积指数（HR：1.02[95%CI：1.00-1.05]）和 E/e'（HR：1.05[95%CI：1.01-1.24]），并超过临床变量（年龄和 Charlson 合并症评分）。然而，GLS 的增加提供了临床和其他超声心动图参数的附加值（P=0.004）。GLS 受损（<18%）（HR：4.09[95%CI：1.87-8.92]）与所有临床和其他超声心动图变量独立且呈正相关，预测 HF，而受损的 LVEF、左心室肥厚、左心房扩大、高 E/e'或 SBHF 均无预测价值。
结论
将 GLS 作为 SBHF 的标准纳入其中，将为 SBHF 的标准标志物预测随后的 HF 入院提供独立且附加的信息。
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