Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea.
Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
Eur Heart J Cardiovasc Imaging. 2023 Sep 26;24(10):1374-1383. doi: 10.1093/ehjci/jead177.
The aim of this study was to investigate the prognostic utility of left ventricular (LV) global longitudinal strain (LV-GLS) in patients with hypertrophic cardiomyopathy (HCM) and an LV ejection fraction (LVEF) of 50-60%.
This retrospective cohort study included 349 patients with HCM and an LVEF of 50-60%. The primary outcome was a composite of cardiovascular death, including sudden cardiac death (SCD) and SCD-equivalent events. The secondary outcomes were SCD/SCD-equivalent events, cardiovascular death (including SCD), and all-cause death. The final analysis included 349 patients (mean age 59.2 ± 14.2 years, men 75.6%). During a median follow-up of 4.1 years, the primary outcome occurred in 26 (7.4%), while the secondary outcomes of SCD/SCD-equivalent events, cardiovascular death, and all-cause death occurred in 15 (4.2%), 20 (5.7%), and 34 (9.7%), respectively. After adjusting for age, atrial fibrillation, ischaemic stroke, LVEF, and left atrial volume index, absolute LV-GLS (%) was independently associated with the primary outcome [adjusted hazard ratio (HR) 0.88, 95% confidence interval (CI) 0.788-0.988, P = 0.029]. According to receiver operating characteristic analysis, 10.5% is an optimal cut-off value for absolute LV-GLS in predicting the primary outcome. Patients with an absolute LV-GLS ≤ 10.5% had a higher risk of the primary outcome than those with an absolute LV-GLS > 10.5% (adjusted HR 2.54, 95% CI 1.117-5.787, P = 0.026). Absolute LV-GLS ≤ 10.5% was an independent predictor for each secondary outcome (P < 0.05).
LV-GLS was an independent predictor of a composite of cardiovascular death, including SCD/SCD-equivalent events, in patients with HCM and an LVEF of 50-60%. Therefore, LV-GLS can help in risk stratification in these patients.
本研究旨在探讨左心室射血分数（LVEF）为 50-60%的肥厚型心肌病（HCM）患者左心室整体纵向应变（LV-GLS）的预后价值。
这是一项回顾性队列研究，纳入了 349 例 LVEF 为 50-60%的 HCM 患者。主要终点为心血管死亡的复合终点，包括心脏性猝死（SCD）和 SCD 等效事件。次要终点为 SCD/SCD 等效事件、心血管死亡（包括 SCD）和全因死亡。最终分析纳入了 349 例患者（平均年龄 59.2±14.2 岁，男性占 75.6%）。中位随访 4.1 年后，主要终点事件发生 26 例（7.4%），次要终点事件的 SCD/SCD 等效事件、心血管死亡和全因死亡分别发生 15 例（4.2%）、20 例（5.7%）和 34 例（9.7%）。在校正年龄、心房颤动、缺血性脑卒中、LVEF 和左心房容积指数后，绝对 LV-GLS（%）与主要终点独立相关[校正后的危险比（HR）0.88，95%置信区间（CI）0.788-0.988，P=0.029]。根据受试者工作特征曲线分析，绝对 LV-GLS 为 10.5%是预测主要终点的最佳截断值。绝对 LV-GLS≤10.5%的患者发生主要终点事件的风险高于绝对 LV-GLS＞10.5%的患者（校正 HR 2.54，95%CI 1.117-5.787，P=0.026）。绝对 LV-GLS≤10.5%是各次要终点的独立预测因素（P＜0.05）。
LV-GLS 是 LVEF 为 50-60%的 HCM 患者心血管死亡复合终点（包括 SCD/SCD 等效事件）的独立预测因子。因此，LV-GLS 有助于对这些患者进行风险分层。
