Brand Anna, Romero Dorta Elena, Wolf Adrian, Blaschke-Waluga Daniela, Seeland Ute, Crayen Claudia, Bischoff Sven, Mattig Isabel, Dreger Henryk, Stangl Karl, Regitz-Zagrosek Vera, Landmesser Ulf, Knebel Fabian, Stangl Verena
Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.
Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
Front Cardiovasc Med. 2023 Feb 20;10:1070450. doi: 10.3389/fcvm.2023.1070450. eCollection 2023.
The predictive value of maximum left atrial volume index (LAVI), phasic left atrial strain (LAS) and other standard echocardiographic parameters assessing left ventricular (LV) diastolic function to discriminate a future worsening of diastolic function (DD) in patients at risk is unclear. We aimed to prospectively assess and compare the clinical impact of these parameters in a randomly selected study sample of the general urban female population.
A comprehensive clinical and echocardiographic evaluation was performed in 256 participants of the Berlin Female Risk Evaluation (BEFRI) trial after a mean follow up time of 6.8 years. After an assessment of participants' current DD status, the predictive impact of an impaired LAS on the course of DD was assessed and compared with LAVI and other DD parameters using receiver operating characteristic (ROC) curve and multivariate logistic regression analyses. Subjects with no DD (DD0) who showed a decline of diastolic function by the time of follow-up showed a reduced LA reservoir (LASr) and conduit strain (LAScd) compared to subjects who remained in the healthy range (LASr 28.0% ± 7.0 vs. 41.9% ± 8.5; LAScd -13.2% ± 5.1 vs. -25.4% ± 9.1; < 0.001). With an area under the curve (AUC) of 0.88 (95%CI 0.82-0.94) and 0.84 (95%CI 0.79-0.89), LASr and LAScd exhibited the highest discriminative value in predicting worsening of diastolic function, whereas LAVI was only of limited prognostic value [AUC 0.63 (95%CI 0.54-0.73)]. In logistic regression analyses, LAS remained a significant predictor for a decline of diastolic function after controlling for clinical and standard echocardiographic DD parameters, indicating its incremental predictive value.
The analysis of phasic LAS may be useful to predict worsening of LV diastolic function in DD0 patients at risk for a future DD development.GRAPHICAL ABSTRACT.
最大左心房容积指数（LAVI）、左心房相位应变（LAS）以及其他评估左心室（LV）舒张功能的标准超声心动图参数对有风险患者未来舒张功能（DD）恶化的预测价值尚不清楚。我们旨在对一般城市女性人群的随机选择研究样本中这些参数的临床影响进行前瞻性评估和比较。
在柏林女性风险评估（BEFRI）试验的256名参与者中进行了全面的临床和超声心动图评估，平均随访时间为6.8年。在评估参与者当前的DD状态后，使用受试者工作特征（ROC）曲线和多变量逻辑回归分析评估LAS受损对DD病程的预测影响，并与LAVI和其他DD参数进行比较。随访时舒张功能出现下降的无DD（DD0）受试者与保持在健康范围内的受试者相比，左心房储备（LASr）和管道应变（LAScd）降低（LASr 28.0%±7.0 vs. 41.9%±8.5；LAScd -13.2%±5.1 vs. -25.4%±9.1；P<0.001）。LASr和LAScd的曲线下面积（AUC）分别为0.88（95%CI 0.82 - 0.94）和0.84（95%CI 0.79 - 0.89），在预测舒张功能恶化方面表现出最高的判别价值，而LAVI的预后价值有限[AUC 0.63（95%CI 0.54 - 0.73）]。在逻辑回归分析中，在控制临床和标准超声心动图DD参数后，LAS仍然是舒张功能下降的显著预测因子，表明其具有增量预测价值。
对相位LAS的分析可能有助于预测有未来DD发展风险的DD0患者左心室舒张功能的恶化。图形摘要。
