Tolvaj Máté, Fábián Alexandra, Tokodi Márton, Lakatos Bálint, Assabiny Alexandra, Ladányi Zsuzsanna, Shiida Kai, Ferencz Andrea, Schwertner Walter, Veres Boglárka, Kosztin Annamária, Szijártó Ádám, Sax Balázs, Merkely Béla, Kovács Attila
Semmelweis University Heart and Vascular Center, Budapest, Hungary.
Front Cardiovasc Med. 2023 Feb 16;10:1082725. doi: 10.3389/fcvm.2023.1082725. eCollection 2023.
Despite the significant contribution of circumferential shortening to the global ventricular function, data are scarce concerning its prognostic value on long-term mortality. Accordingly, our study aimed to assess both left (LV) and right ventricular (RV) global longitudinal (GLS) and global circumferential strain (GCS) using three-dimensional echocardiography (3DE) to determine their prognostic importance.
Three hundred fifty-seven patients with a wide variety of left-sided cardiac diseases were retrospectively identified (64 ± 15 years, 70% males) who underwent clinically indicated 3DE. LV and RV GLS, and GCS were quantified. To determine the prognostic power of the different patterns of biventricular mechanics, we divided the patient population into four groups. Group 1 consisted of patients with both LV GLS and RV GCS above the respective median values; Group 2 was defined as patients with LV GLS below the median while RV GCS above the median, whereas in Group 3, patients had LV GLS values above the median, while RV GCS was below median. Group 4 was defined as patients with both LV GLS and RV GCS below the median. Patients were followed up for a median of 41 months. The primary endpoint was all-cause mortality.
Fifty-five patients (15%) met the primary endpoint. Impaired values of both LV GCS (HR, 1.056 [95% CI, 1.027-1.085], < 0.001) and RV GCS (1.115 [1.068-1.164], < 0.001) were associated with increased risk of death by univariable Cox regression. Patients with both LV GLS and RV GCS below the median (Group 4) had a more than 5-fold increased risk of death compared with those in Group 1 (5.089 [2.399-10.793], < 0.001) and more than 3.5-fold compared with those in Group 2 (3.565 [1.256-10.122], = 0.017). Interestingly, there was no significant difference in mortality between Group 3 (with LV GLS above the median) and Group 4, but being categorized into Group 3 versus Group 1 still held a more than 3-fold risk (3.099 [1.284-7.484], = 0.012).
The impaired values of both LV and RV GCS are associated with long-term all-cause mortality, emphasizing the importance of assessing biventricular circumferential mechanics. Reduced RV GCS is associated with significantly increased risk of mortality even if LV GLS is preserved.
尽管圆周缩短对整体心室功能有重大贡献，但关于其对长期死亡率的预后价值的数据却很少。因此，我们的研究旨在使用三维超声心动图（3DE）评估左心室（LV）和右心室（RV）的整体纵向应变（GLS）和整体圆周应变（GCS），以确定它们的预后重要性。
回顾性纳入357例患有各种左侧心脏病的患者（64±15岁，70%为男性），他们接受了临床指征的3DE检查。对左心室和右心室的GLS以及GCS进行了量化。为了确定双心室力学不同模式的预后能力，我们将患者人群分为四组。第1组由左心室GLS和右心室GCS均高于各自中位数的患者组成；第2组定义为左心室GLS低于中位数而右心室GCS高于中位数的患者，而在第3组中，患者左心室GLS值高于中位数，而右心室GCS低于中位数。第4组定义为左心室GLS和右心室GCS均低于中位数的患者。对患者进行了中位41个月的随访。主要终点是全因死亡率。
55例患者（15%）达到主要终点。左心室GCS（HR，1.056[95%CI，1.027 - 1.085]，P<0.001）和右心室GCS（1.115[1.068 - 1.164]，P<0.001）的受损值与单变量Cox回归分析中死亡风险增加相关。左心室GLS和右心室GCS均低于中位数的患者（第4组）与第1组患者相比，死亡风险增加了5倍以上（5.089[2.399 - 10.793]，P<0.001），与第2组患者相比增加了3.5倍以上（3.565[1.256 - 10.122]，P = 0.017）。有趣的是，第3组（左心室GLS高于中位数）和第4组之间的死亡率没有显著差异，但与第1组相比，被归类为第3组的患者仍有3倍以上的风险（3.099[1.284 - 7.484]，P = 0.012）。
左心室和右心室GCS的受损值与长期全因死亡率相关，强调了评估双心室圆周力学的重要性。即使左心室GLS保持正常，右心室GCS降低也与死亡率显著增加相关。
