Mandoli Giulia Elena, Pastore Maria Concetta, Benfari Giovanni, Setti Martina, Maritan Luca, Diviggiano Enrico Emilio, D'Ascenzi Flavio, Focardi Marta, Cavigli Luna, Valente Serafina, Cameli Matteo
Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy.
Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
Front Cardiovasc Med. 2023 Jan 11;9:1079632. doi: 10.3389/fcvm.2022.1079632. eCollection 2022.
In chronic heart failure, high intracardiac pressures induce a progressive remodeling of small pulmonary arteries up to pulmonary hypertension. At the end of left atrial conduit function, pulmonary and left heart end-systolic pressures equalization might affect left atrial systole. In this single-center prospective study, we aimed to investigate whether peak atrial contraction strain (PACS), measured by speckle tracking echocardiography, was independently associated with prognosis in heart failure with reduced ejection fraction (HFrEF).
Outpatients with HFrEF and sinus rhythm referred to our echo-labs were enrolled. After clinical and echocardiographic evaluation, off-line speckle tracking echocardiography analysis was performed. Primary and secondary endpoint were cardiovascular death and heart failure hospitalization, respectively. Spline knotted survival model identified the optimal prognostic cut-off for PACS.
The 152 patients were stratified based on PACS <8% ( = 76) or PACS ≥8% ( = 76). Patients with PACS <8% had lower left ventricle and left atrial reservoir strain and higher New York Heart Association (NYHA) class and left atrial volume index (LAVI). Over a mean follow-up of 3.4 ± 2 years, 117 events (51 cardiovascular death, 66 heart failure hospitalizations) were collected. By univariate and multivariate Cox analysis, PACS emerged as a strong and independent predictor of cardiovascular death and heart failure hospitalization, after adjusting for age, sex, left ventricle strain, and E/e', LAVI (HR 0.6 per 5 unit-decrease in PACS). Kaplan-Meier curves showed a sustained divergence in event-free survival rates for the two groups.
The reduction of PACS significantly and independently affects cardiovascular outcome in HFrEF. Therefore, its assessment, although limited to patients with sinus rhythm, could offer additive prognostic information for HFrEF patients.
在慢性心力衰竭中，心腔内高压会导致小肺动脉进行性重塑，直至发生肺动脉高压。在左心房管道功能末期，肺循环和左心收缩末期压力平衡可能会影响左心房收缩。在这项单中心前瞻性研究中，我们旨在调查通过斑点追踪超声心动图测量的心房收缩峰值应变（PACS）是否与射血分数降低的心力衰竭（HFrEF）患者的预后独立相关。
纳入转诊至我们超声心动图实验室的HFrEF和窦性心律门诊患者。经过临床和超声心动图评估后，进行离线斑点追踪超声心动图分析。主要终点和次要终点分别为心血管死亡和心力衰竭住院。样条结生存模型确定了PACS的最佳预后临界值。
152例患者根据PACS<8%（n = 76）或PACS≥8%（n = 76）进行分层。PACS<8%的患者左心室和左心房储备应变较低，纽约心脏协会（NYHA）分级和左心房容积指数（LAVI）较高。在平均3.4±2年的随访期内，共收集到117例事件（51例心血管死亡，66例心力衰竭住院）。通过单因素和多因素Cox分析，在调整年龄、性别、左心室应变、E/e'、LAVI后，PACS成为心血管死亡和心力衰竭住院的强有力独立预测因素（PACS每降低5个单位，HR为0.6）。Kaplan-Meier曲线显示两组无事件生存率持续存在差异。
PACS降低显著且独立地影响HFrEF患者的心血管结局。因此，尽管其评估仅限于窦性心律患者，但可为HFrEF患者提供额外的预后信息。
