三维斑点追踪超声心动图衍生的左心室整体纵向应变在心脏淀粉样变性中的预后作用：来自 MAGYAR-Path 研究的见解。

Prognostic role of three-dimensional speckle-tracking echocardiography-derived left ventricular global longitudinal strain in cardiac amyloidosis: Insights from the MAGYAR-Path Study.

机构信息

Division of Haematology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary.

Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary.

出版信息

J Clin Ultrasound. 2023 Jul-Aug;51(6):952-959. doi: 10.1002/jcu.23445. Epub 2023 Feb 24.

DOI:10.1002/jcu.23445

PMID:36840337

Abstract

INTRODUCTION

Systemic amyloidosis is an uncommon disorder in which amyloid fibrils deposit extracellularly. Three-dimensional speckle-tracking echocardiography (3DSTE) is a novel method able to assess left ventricular (LV) global longitudinal strain (GLS). Our aim was to evaluate the prognostic impact of 3DSTE-derived LV-GLS in patients with cardiac amyloidosis (CA).

MATERIALS AND METHODS

A total of 35 patients suffering from light-chain (AL) CA or transthyretin (TTR) CA were selected, but 7 patients had to be excluded due to insufficient image quality or were lost for follow-up. With AL-CA 23 cases, while for TTR-CA 5 patients were diagnosed. Complete two-dimensional Doppler and 3DSTE were performed in all subjects.

RESULTS

The median follow-up was 201 days (ranging from 36 to 632 days) during which cardiovascular event was detected in 17 CA patients, including 8 cardiac deaths. Six patients were diagnosed with acute heart failure, two patients needed invasive interventions (percutaneous coronary intervention with stent-implantation, implantable cardioverter defibrillator implantation) and in one patient new higher grade atrioventricular block was registered. Using ROC analysis, 3DSTE-derived LV-GLS ≥11.8% (absolute value) was found to be a significant predictor for cardiovascular event-free survival (sensitivity 65%, specificity 64%, area under the curve 0.71, p = .05). Lower LV ejection fraction was confirmed in patients with LV-GLS <11.8% as compared to cases with LV-GLS ≥11.8%. In case of a cardiovascular event, LV-GLS was lower as compared to that of subjects with no events. Multivariable regression analysis confirmed that LV-GLS and LV end-diastolic diameter were independent predictors of cardiovascular survival.

CONCLUSION

3DSTE-derived LV-GLS is an independent predictor for future cardiovascular events in CA patients.

摘要

简介

系统性淀粉样变性是一种罕见的疾病，其中淀粉样纤维沉积在细胞外。三维斑点追踪超声心动图（3DSTE）是一种能够评估左心室（LV）整体纵向应变（GLS）的新方法。我们的目的是评估 3DSTE 衍生的 LV-GLS 在心脏淀粉样变性（CA）患者中的预后影响。

材料和方法

共选择了 35 名患有轻链（AL）CA 或转甲状腺素（TTR）CA 的患者，但由于图像质量不足或随访丢失，有 7 名患者不得不被排除在外。在 AL-CA 中有 23 例，而在 TTR-CA 中有 5 例被诊断。所有患者均进行了完整的二维多普勒和 3DSTE 检查。

结果

中位随访时间为 201 天（范围为 36 至 632 天），在此期间，17 名 CA 患者发生了心血管事件，包括 8 例心脏死亡。6 名患者被诊断为急性心力衰竭，2 名患者需要进行介入治疗（经皮冠状动脉介入治疗和植入式心脏复律除颤器植入），1 名患者新出现更高一级的房室传导阻滞。通过 ROC 分析，发现 3DSTE 衍生的 LV-GLS≥11.8%（绝对值）是心血管事件无事件生存率的显著预测因子（敏感性 65%，特异性 64%，曲线下面积 0.71，p=0.05）。与 LV-GLS≥11.8%的患者相比，LV-GLS<11.8%的患者左心室射血分数较低。在发生心血管事件的情况下，LV-GLS 低于无事件的患者。多变量回归分析证实，LV-GLS 和 LV 舒张末期直径是心血管生存的独立预测因子。