Brann Alison, Miller James, Eshraghian Emily, Park Jin Joo, Greenberg Barry
Division of Cardiology, University of California San Diego, La Jolla, CA, USA.
Department of Internal Medicine, University of California San Diego, La Jolla, CA, USA.
Eur J Heart Fail. 2023 Oct;25(10):1755-1765. doi: 10.1002/ejhf.2947. Epub 2023 Jul 24.
Patients with heart failure with preserved ejection fraction (HFpEF) are at high risk for hospitalization and mortality and many of these patients experience a deterioration in left ventricular ejection fraction (LVEF) over time. Global longitudinal strain (GLS) is a sensitive marker of myocardial dysfunction that could help predict risk for future events in this population. We assessed whether GLS can predict adverse clinical outcomes and future deterioration in LVEF in patients with HFpEF.
In this retrospective cohort study, patients with HFpEF were divided into groups according to abnormal GLS (>-15.8%) or normal GLS (<-15.8%).The primary outcomes were: a composite of cardiovascular mortality or heart failure hospitalization and deterioration in LVEF to <40%. Among the 311 patients with HFpEF, 128 patients (41%) had normal GLS and 183 patients (59%) had abnormal GLS. After a median follow-up of 4.6 years, the composite outcome occurred more commonly in patients with abnormal GLS compared to patients with normal GLS (62% vs. 44%; hazard ratio [HR] 1.74, 95% confidence interval [CI] 1.3-2.4, p < 0.001). Patients with abnormal GLS were also more likely to experience a deterioration in LVEF (19% vs. 10%; HR 2.2, 95% CI 1.2-4.3, p = 0.018). When assessed as a continuous variable, each 1% increase in GLS was associated with 10% increased odds for the composite outcome and 13% increased odds for deterioration in LVEF.
In patients with HFpEF, abnormal GLS is common and is a strong predictor for clinical events and future deterioration in LVEF.
射血分数保留的心力衰竭（HFpEF）患者住院和死亡风险较高，且许多患者的左心室射血分数（LVEF）会随时间恶化。整体纵向应变（GLS）是心肌功能障碍的敏感标志物，有助于预测该人群未来事件的风险。我们评估了GLS是否能预测HFpEF患者的不良临床结局和未来LVEF的恶化。
在这项回顾性队列研究中，HFpEF患者根据GLS异常（>-15.8%）或正常（<-15.8%）进行分组。主要结局为：心血管死亡或心力衰竭住院的复合结局以及LVEF恶化至<40%。在311例HFpEF患者中，128例（41%）GLS正常，183例（59%）GLS异常。中位随访4.6年后，与GLS正常的患者相比，GLS异常的患者更常出现复合结局（62%对44%；风险比[HR]1.74，95%置信区间[CI]1.3 - 2.4，p<0.001）。GLS异常的患者也更有可能出现LVEF恶化（19%对10%；HR 2.2，95%CI 1.2 - 4.3，p = 0.018）。当作为连续变量评估时，GLS每增加1%，复合结局的几率增加10%，LVEF恶化的几率增加13%。
在HFpEF患者中，GLS异常常见，是临床事件和未来LVEF恶化的有力预测指标。
