Division of Cardiology, Department of Medicine, UT Southwestern Medical Center, Dallas, TX, USA.
Parkland Health and Hospital System, Dallas, TX, USA.
Eur J Heart Fail. 2024 Feb;26(2):208-215. doi: 10.1002/ejhf.3158. Epub 2024 Feb 12.
Left ventricular (LV) global longitudinal strain (GLS) may detect subtle abnormalities in myocardial contractility among individuals with normal LV ejection fraction (LVEF). However, the prognostic implications of GLS among healthy, community-dwelling adults is not well-established.
Overall, 2234 community-dwelling adults (56% women, 47% Black) with LVEF ≥50% without a history of cardiovascular disease (CVD) from the Dallas Heart Study who underwent cardiac magnetic resonance (CMR) with GLS assessed by feature tracking CMR (FT-CMR) were included. The association of GLS with the risk of incident major adverse cardiovascular events (MACE; composite of incident myocardial infarction, incident heart failure [HF], hospitalization for atrial fibrillation, coronary revascularization, and all-cause death), and incident HF or death were assessed with adjusted Cox proportional hazards models. A total of 309 participants (13.8%) had MACE during a median follow-up duration of 17 years. Participants with the worst GLS (Q4) were more likely male and of the Black race with a history of tobacco use and diabetes with lower LVEF, higher LV end-diastolic volume, and higher LV mass index. Cumulative incidence of MACE was higher among participants with worse (Q4 vs. Q1) GLS (20.4% vs. 9.0%). In multivariable-adjusted Cox models that included clinical characteristics, cardiac biomarkers and baseline LVEF, worse GLS (Q4 vs. Q1) was associated with a significantly higher risk of MACE (hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.07-2.24, p = 0.02) and incident HF or death (HR 1.57, 95% CI 1.03-2.38, p = 0.04).
Impaired LV GLS assessed by FT-CMR among adults free of cardiovascular disease is associated with a higher risk of incident MACE and incident HF or death independent of cardiovascular risk factors, cardiac biomarkers and LVEF.
左心室（LV）整体纵向应变（GLS）可检测到射血分数正常（LVEF）的个体心肌收缩力的细微异常。然而，GLS 在健康的社区居住成年人中的预后意义尚未得到充分确立。
共有 2234 名来自达拉斯心脏研究的无心血管疾病（CVD）病史且 LVEF≥50%的社区居住成年人（女性占 56%，黑人占 47%）接受了心脏磁共振（CMR）检查，包括通过特征跟踪 CMR（FT-CMR）评估的 GLS。使用调整后的 Cox 比例风险模型评估 GLS 与主要不良心血管事件（MACE；心肌梗死、心力衰竭[HF]、心房颤动住院、冠状动脉血运重建和全因死亡的综合事件）的风险之间的相关性，以及与 HF 或死亡的相关性。中位随访 17 年后，共有 309 名参与者（13.8%）发生 MACE。GLS 最差（Q4）的参与者更可能为男性和黑人，有吸烟和糖尿病史，LVEF 较低，LV 舒张末期容积较高，LV 质量指数较高。GLS 较差（Q4 与 Q1）的参与者累积 MACE 发生率更高（20.4% vs. 9.0%）。在包括临床特征、心脏生物标志物和基线 LVEF 的多变量调整 Cox 模型中，GLS 较差（Q4 与 Q1）与更高的 MACE 风险显著相关（风险比[HR] 1.55，95%置信区间[CI] 1.07-2.24，p=0.02）和 HF 或死亡的发生率（HR 1.57，95% CI 1.03-2.38，p=0.04）。
在无心血管疾病的成年人中，FT-CMR 评估的 LV GLS 受损与心血管危险因素、心脏生物标志物和 LVEF 无关，与较高的新发 MACE 和 HF 或死亡风险相关。
