Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Department of Laboratory and Transfusion Medicine, Hospital of University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
Int J Cardiol. 2024 Dec 1;416:132487. doi: 10.1016/j.ijcard.2024.132487. Epub 2024 Aug 28.
To examine whether left atrial (LA) strain was associated with adverse outcomes in asymptomatic chronic aortic regurgitation (AR).
Asymptomatic patients with ≥moderate-severe AR were retrospectively identified from 2008 through 2022 from a university hospital. Apical 4-chamber left ventricular longitudinal strain (A4C-LVLS), LA reservoir (LASr), conduit (LAScd), and contractile strain (LASct) were measured using fully-automated software. Primary endpoint was all-cause death (ACD); secondary endpoints were heart failure (HF) development or aortic valve surgery (AVS).
Of 352 patients (59 ± 17 years; 19 % female), the mean LV ejection fraction (LVEF) was 60 ± 8 %. The median follow-up during medical surveillance was 4.7 (interquartile range: 1.8-9.0) years; during which 68 patients died. Multivariable analysis adjusted for covariates showed that larger maximal LA volume index (iLAVmax), lower LASr and LASct were independently associated with ACD (all P ≤ 0.047); A4C-LVLS and LAScd were not (P ≥ 0.15). Besides, iLAVmax, LASr, and LASct provided incremental prognostic value over A4C-LVLS in terms of ACD (all P ≤ 0.048). HF symptoms occurred in 126 patients at a median of 2 years. Multivariable determinants for HF development included larger minimal LAV index, lower LASr and LASct (all P ≤ 0.03). Adjusted spline curves showed LASr <38-40 % and LASct <20-24 % were associated with increased risks of ACD and HF development, respectively. Using abovementioned LASr and LASct cutoffs, adjusted Kaplan-Meier curves risk-stratified patients for ACD successfully (P ≤ 0.02). Lower LASr was also independently associated with AVS (Hazard ratio per 1 % increase: 0.98)(P = 0.02).
In patients with asymptomatic AR, fully-automated LASr and LASct were robust markers for outcome determination; these markers may identify those who need timely surgical referral.
研究左心房（LA）应变是否与无症状慢性主动脉瓣反流（AR）的不良结局相关。
从 2008 年至 2022 年，我们从一所大学医院回顾性地确定了患有≥中度至重度 AR 的无症状患者。使用全自动软件测量心尖 4 腔室左心室纵向应变（A4C-LVLS）、LA 储器（LASr）、导管（LAScd）和收缩应变（LASct）。主要终点为全因死亡（ACD）；次要终点为心力衰竭（HF）的发生或主动脉瓣手术（AVS）。
在 352 名患者（59±17 岁；19%为女性）中，平均左心室射血分数（LVEF）为 60±8%。在医学监测期间的中位随访时间为 4.7 年（四分位距：1.8-9.0）；在此期间，68 名患者死亡。多变量分析调整了协变量，结果表明，最大左心房容量指数（iLAVmax）越大，LASr 和 LASct 越低，与 ACD 独立相关（均 P≤0.047）；A4C-LVLS 和 LAScd 则没有（P≥0.15）。此外，iLAVmax、LASr 和 LASct 在 ACD 方面提供了比 A4C-LVLS 更具增量预后价值（均 P≤0.048）。126 名患者在中位数为 2 年时出现 HF 症状。HF 发展的多变量决定因素包括更小的最小 LAV 指数、更低的 LASr 和 LASct（均 P≤0.03）。调整后的样条曲线显示，LASr<38-40%和 LASct<20-24%分别与 ACD 和 HF 发展风险增加相关。使用上述 LASr 和 LASct 截止值，调整后的 Kaplan-Meier 曲线成功地对 ACD 患者进行风险分层（P≤0.02）。LASr 降低也与 AVS 独立相关（每增加 1%的风险比：0.98）（P=0.02）。
在无症状 AR 患者中，全自动 LASr 和 LASct 是确定结局的可靠标志物；这些标志物可以识别那些需要及时进行手术转诊的患者。
