Giucă Adrian, Galloo Xavier, Meucci Maria Chiara, Butcher Steele C, Popescu Bogdan Alexandru, Jurcuț Ruxandra, Săftoiu Adrian, Jurcuț Ciprian, Groșeanu Laura, Mușetescu Anca Emanuela, Ahmed Saad, De Vries-Bouwstra Jeska, Bax Jeroen J, Ajmone Marsan Nina
Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands.
"Prof. Dr. C.C. Iliescu" Emergency Institute for Cardiovascular Diseases, Fundeni Street 258, 022328 Bucharest, Romania.
J Cardiovasc Dev Dis. 2024 Oct 7;11(10):310. doi: 10.3390/jcdd11100310.
Systemic sclerosis (SSc) is a multisystemic autoimmune disorder in which cardiac involvement is frequent and portends negative prognosis. Left ventricular (LV) diastolic dysfunction is one of the most common cardiac alterations in these patients, and left atrial (LA) reservoir strain (Ɛ) measurement using speckle tracking echocardiography has been proposed as a novel parameter for a better assessment of LV diastolic function. Therefore, the aim of this study was to test the prognostic value of Ɛ in a large multicenter cohort of SSc patients. In total, 311 SSc patients (54 ± 14 years, 85% female) were included from two different centers. Echocardiography was performed at the time of first visit, including Ɛ measurement. Over a median follow-up of 132 (interquartile range: 110 to 157) months, 67 (21.5%) patients experienced the outcome of all-cause mortality. Spline curve analysis identified an optimal cut-off value of 30% for Ɛ, and patients with Ɛ ≤ 30% showed a 10-year cumulative survival rate of 71% as compared to 88% for patients with Ɛ > 30% (log-rank < 0.001). At the multivariable Cox regression analysis, Ɛ was independently associated with the endpoint (HR 1.830; 95% confidence interval (CI) 1.031-3.246; = 0.039) together with age (HR 1.071, 95% CI 1.043 to 1.099; < 0.001), sex (female) (HR 0.444, 95% CI 0.229 to 0.861; = 0.016), and diffusing lung capacity for carbon monoxide (HR 0.969 95% CI 0.956 to 0.982; < 0.001). Ɛ is of independent prognostic value in SSc and might help optimizing risk stratification in these patients.
系统性硬化症（SSc）是一种多系统自身免疫性疾病，心脏受累较为常见且预示着不良预后。左心室（LV）舒张功能障碍是这些患者最常见的心脏改变之一，使用斑点追踪超声心动图测量左心房（LA）储备应变（Ɛ）已被提议作为更好评估LV舒张功能的一个新参数。因此，本研究的目的是在一个大型多中心SSc患者队列中测试Ɛ的预后价值。总共从两个不同中心纳入了311例SSc患者（54±14岁，85%为女性）。在首次就诊时进行超声心动图检查，包括Ɛ测量。在中位随访132（四分位间距：110至157）个月期间，67例（21.5%）患者出现全因死亡结局。样条曲线分析确定Ɛ的最佳截断值为30%，Ɛ≤30%的患者10年累积生存率为71%，而Ɛ>30%的患者为88%（对数秩检验<0.001）。在多变量Cox回归分析中，Ɛ与年龄（HR 1.071，95%置信区间（CI）1.043至1.099；P<0.001）、性别（女性）（HR 0.444，95%CI 0.229至0.861；P = 0.016）以及一氧化碳弥散量（HR 0.969，95%CI 0.956至0.982；P<0.001）一起与终点独立相关（HR 1.830；95%CI 1.031 - 3.246；P = 0.039）。Ɛ在SSc中具有独立的预后价值，可能有助于优化这些患者的风险分层。
