二维和三维斑点追踪超声心动图测量的左心室整体纵向应变在射血分数保留的心力衰竭患者中的预后价值

Prognostic Value of LV Global Longitudinal Strain by 2D and 3D Speckle-Tracking Echocardiography in Patients With HFpEF.

作者信息

Lin Yixia, Xie Mingxing, Zhang Li, Zhang Yanting, Zhang Peige, Chen Xin, Ji Mengmeng, Gao Lang, He Qing, Wu Zhenni, Yang Yali, Li Yuman

机构信息

Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Y. Lin, M.X., L.Z., Y.Z., P.Z., X.C., M.J., L.G., Q.H., Z.W., Y.Y., Y. Li).

Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China (Y. Lin, M.X., L.Z., Y.Z., P.Z., X.C., M.J., L.G., Q.H., Z.W., Y.Y., Y. Li).

出版信息

Circ Cardiovasc Imaging. 2025 Feb;18(2):e016975. doi: 10.1161/CIRCIMAGING.124.016975. Epub 2025 Jan 13.

DOI:10.1161/CIRCIMAGING.124.016975

PMID:39801478

Abstract

BACKGROUND

In patients with heart failure with preserved ejection fraction (HFpEF), the impact of type 2 diabetes (T2D) on left ventricular global longitudinal strain (LV GLS) and its prognostic implications remains unclear. We aimed to evaluate LV function using two-dimensional (2D) and three-dimensional (3D) speckle-tracking echocardiography in patients with HFpEF with and without T2D, and to investigate its prognostic significance.

METHODS

A total of 335 patients with HFpEF were prospectively enrolled for echocardiographic evaluation. LV GLS was obtained using 2D- and 3D-speckle-tracking echocardiography. Cox proportional hazards regression was used to determine predictors of adverse outcomes. The C-index, Akaike information criterion, integrated discrimination improvement, and net reclassification improvement were used to assess model performance and discriminative ability.

RESULTS

LV 2D-GLS and 3D-GLS were impaired in patients with HFpEF and T2D compared with those without T2D. After a median follow-up of 17.6 months, 150 patients experienced adverse outcomes. Both 2D-GLS (hazard ratio, 1.323 [95% CI, 1.225-1.429]; <0.001) and 3D-GLS (hazard ratio, 1.412 [95% CI, 1.316-1.515]; <0.001) were independent predictors of adverse outcomes in patients with HFpEF after adjustment for confounders. The predictive accuracy of a model incorporating 3D-GLS (Akaike information criterion=-583.9, C-index=0.775 [95% CI, 0.742-0.808]) was superior to models using 2D-GLS (Akaike information criterion=-533.3, C-index=0.719 [95% CI, 0.678-0.760], ΔC-index=0.056; =0.034) and LV ejection fraction (Akaike information criterion=-498.9, C-index=0.659 [95% CI, 0.610-0.708], ΔC-index=0.116; <0.001). The addition of 2D-GLS and 3D-GLS to the base model significantly enhanced its discriminatory and predictive abilities (integrated discrimination improvement=0.225 and 0.280; net reclassification improvement=0.612 and 0.734, respectively, <0.001 for all).

CONCLUSIONS

LV 2D-GLS and 3D-GLS are impaired in patients with HFpEF and T2D, and are independent predictors of adverse outcomes. Moreover, 3D-GLS provides incremental prognostic value over 2D-GLS.

REGISTRATION

URL: https://www.chictr.org.cn/; Unique identifier: ChiCTR2100047487.

摘要

背景

在射血分数保留的心力衰竭（HFpEF）患者中，2型糖尿病（T2D）对左心室整体纵向应变（LV GLS）的影响及其预后意义尚不清楚。我们旨在使用二维（2D）和三维（3D）斑点追踪超声心动图评估合并和不合并T2D的HFpEF患者的左心室功能，并探讨其预后意义。

方法

共前瞻性纳入335例HFpEF患者进行超声心动图评估。使用2D和3D斑点追踪超声心动图获得LV GLS。采用Cox比例风险回归确定不良结局的预测因素。使用C指数、赤池信息准则、综合判别改善和净重新分类改善来评估模型性能和判别能力。

结果

与不合并T2D的患者相比，合并HFpEF和T2D的患者LV 2D-GLS和3D-GLS受损。中位随访17.6个月后，150例患者出现不良结局。校正混杂因素后，2D-GLS（风险比，1.323[95%CI，1.225-1.429]；<0.001）和3D-GLS（风险比，1.412[95%CI，1.316-1.515]；<0.001）均为HFpEF患者不良结局的独立预测因素。纳入3D-GLS的模型（赤池信息准则=-583.9，C指数=0.775[95%CI，0.742-0.808]）的预测准确性优于使用2D-GLS（赤池信息准则=-533.3，C指数=0.719[95%CI，0.678-0.760]，ΔC指数=0.056；P=0.034）和左心室射血分数（赤池信息准则=-498.9，C指数=0.659[95%CI，0.6