Zhu Shuangshuang, Wu Chun, Zhang Yiwei, Qiao Weihua, Dong Nianguo, Li Yuman, Xie Mingxing, Zhang Li
Department of Ultrasound Medicine Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan China.
Clinical Research Center for Medical Imaging in Hubei Province Wuhan China.
J Am Heart Assoc. 2024 Dec 3;13(23):e036596. doi: 10.1161/JAHA.124.036596. Epub 2024 Nov 27.
The prognostic value of 3-dimensional (3D)-left ventricular global longitudinal strain (LVGLS) in recipients of heart transplant (HT) reremains unknown. This study aimed to determine whether 3D-LVGLS was the more powerful predictor of poor outcomes in recipients of HT compared with 2-dimensional (2D)-LVGLS.
All consecutive adult patients who received HT and underwent at least 1 comprehensive 2D and 3D transthoracic echocardiographic examination for clinical surveillance were retrospectively enrolled. The end point was all-cause mortality. Prognostic model performance was assessed according to the C-statistic. The 3D-LVGLS measurements were feasible in 294 of 342 patients with HT (86%). The median follow-up time was 53 months, and 44 HT redied. Receiver operating characteristic curves revealed that the area under the curve for predicting all-cause mortality was greater for 3D-LVGLS than 2D-LVGLS (0.77 versus 0.67, =0.012). When HT stratified patients with HT into tertiles according to 3D-LVGLS values, patients with lower 3D-LVGLS had worse outcome (<0.001). The multivariable Cox analysis showed that the model with 3D-LVGLS (hazard ratio [HR],1.44 [95% CI,1.24-1.68]; <0.001; C-statistic=0.814) was better in predicting death than the model with 2D-LVGLS (HR, 1.19 [95% CI, 1.06-1.32]; =0.002; C-statistic=0.772). The best cutoff value of 3D-LVGLS for detecting all-cause mortality was -16.1%, with a sensitivity of 63.6% and a specificity of 84.0%.
The 3D-LVGLS was a powerful predictor of all-cause mortality in patients receiving HT and provided greater prognostic value than 2D-LVGLS. Our study highlighted the potential of evaluating 3D-LVGLS for risk stratification in recipients of HT.
三维（3D）左心室整体纵向应变（LVGLS）在心脏移植（HT）受者中的预后价值尚不清楚。本研究旨在确定与二维（2D）-LVGLS相比，3D-LVGLS是否是HT受者不良结局的更强有力预测指标。
回顾性纳入所有接受HT并为临床监测至少进行1次全面二维和三维经胸超声心动图检查的连续成年患者。终点为全因死亡率。根据C统计量评估预后模型性能。342例HT患者中有294例（86%）可行3D-LVGLS测量。中位随访时间为53个月，44例HT患者死亡。受试者工作特征曲线显示，预测全因死亡率时，3D-LVGLS的曲线下面积大于2D-LVGLS（0.77对0.67，P=0.012）。根据3D-LVGLS值将HT患者分层为三分位数时，3D-LVGLS较低的患者结局较差（P<0.001）。多变量Cox分析显示，包含3D-LVGLS的模型（风险比[HR]，1.44[95%CI，1.24-1.68]；P<0.001；C统计量=0.814）在预测死亡方面优于包含2D-LVGLS的模型（HR，1.19[95%CI，1.06-1.32]；P=0.002；C统计量=0.772）。检测全因死亡率的3D-LVGLS最佳截断值为-16.1%，敏感性为63.6%，特异性为84.0%。
3D-LVGLS是HT患者全因死亡率的有力预测指标，比2D-LVGLS具有更大的预后价值。我们的研究强调了评估3D-LVGLS用于HT受者风险分层的潜力。
