使用心血管磁共振特征追踪的双心室纵向应变分析：艾森曼格综合征的预后价值。
Biventricular longitudinal strain analysis using cardiovascular magnetic resonance feature-tracking: Prognostic value in Eisenmenger syndrome.
作者信息
Gong Chao, Chen Chen, Liu Xuhan, Wan Ke, Guo Jiajun, He Juan, Yin Lidan, Wen Bi, Pu Shoufang, Chen Yucheng
机构信息
Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China; Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, PR China.
Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China.
出版信息
J Cardiovasc Magn Reson. 2024;26(2):101116. doi: 10.1016/j.jocmr.2024.101116. Epub 2024 Oct 28.
BACKGROUND
Evidence to support risk stratification in Eisenmenger syndrome (ES) is still very limited. We hypothesized that biventricular longitudinal strain analysis could have potential prognostic value in ES.
METHODS
We prospectively enrolled 57 consecutive ES patients with post-tricuspid shunt who underwent both cardiovascular magnetic resonance (CMR) and right heart catheterization between June 2013 and March 2022. Biventricular longitudinal strains were evaluated by CMR feature-tracking analysis. The composite endpoint included all-cause mortality and re-admission for heart failure or hemoptysis. Cox regression analysis, Kaplan-Meier curves, and C-index were employed to assess the relationship between biventricular longitudinal strain and prognosis.
RESULTS
During a median follow-up of 33 months (interquartile range: 12-50), 35.1% (20/57) patients reached the composite endpoint. Patients with composite endpoints had significantly lower absolute values of left ventricular global longitudinal strain (LV GLS) and right ventricular free wall longitudinal strain (RV FWLS) than patients without composite endpoints (p < .05). Multivariate Cox regression analysis demonstrated that LV GLS and RV FWLS were independent predictors for composite endpoints (hazard ratio [HR]: 1.37, 95% confidence interval [CI]: 1.08-1.75, p = 0.010 and HR: 1.19, 95% CI: 1.01-1.41, p = 0.042). Kaplan-Meier analysis indicated that patients with both lower absolute values of LV GLS and RV FWLS were more likely to be at an even higher risk of composite endpoints (p <0.001). Furthermore, the combined addition of LV GLS and RV FWLS provided incremental value for the prognostic model including clinical parameters and biventricular ejection fraction (C-index increased from 0.75 to 0.86, p = 0.004).
CONCLUSION
Impaired biventricular longitudinal strains improved prognostic prediction of ES patients with post-tricuspid shunt.
背景
支持艾森曼格综合征（ES）风险分层的证据仍然非常有限。我们假设双心室纵向应变分析可能对ES具有潜在的预后价值。
方法
我们前瞻性纳入了57例连续的三尖瓣后分流型ES患者，这些患者在2013年6月至2022年3月期间接受了心血管磁共振成像（CMR）和右心导管检查。通过CMR特征追踪分析评估双心室纵向应变。复合终点包括全因死亡率以及因心力衰竭或咯血再次入院。采用Cox回归分析、Kaplan-Meier曲线和C指数来评估双心室纵向应变与预后之间的关系。
结果
在中位随访33个月（四分位间距：12 - 50个月）期间，35.1%（20/57）的患者达到复合终点。达到复合终点的患者左心室整体纵向应变（LV GLS）和右心室游离壁纵向应变（RV FWLS）的绝对值显著低于未达到复合终点的患者（p < 0.05）。多变量Cox回归分析表明，LV GLS和RV FWLS是复合终点的独立预测因素（风险比[HR]：1.37，95%置信区间[CI]：1.08 - 1.75，p = 0.010；HR：1.19，95% CI：1.01 - 1.41，p = 0.042）。Kaplan-Meier分析表明，LV GLS和RV FWLS绝对值均较低的患者发生复合终点的风险甚至更高（p < 0.001）。此外，将LV GLS和RV FWLS联合纳入包括临床参数和双心室射血分数的预后模型可增加模型价值（C指数从0.75增加到0.86，p = 0.004）。
结论
双心室纵向应变受损可改善三尖瓣后分流型ES患者的预后预测。
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