Chen Jingwan, Wang Xidan, Chen Fuhua, Weng Wenchao, Tang Biao, Zhou Yibo
Department of Ultrasound, JinHua Municipal Central Hospital, Jinhua, Zhejiang, China.
Department of Cardiology, JinHua Municipal Central Hospital, Jinhua, Zhejiang, China.
Medicine (Baltimore). 2025 Jan 17;104(3):e41274. doi: 10.1097/MD.0000000000041274.
To evaluate myocardial synchronized exercise and clinical prognosis in patients with heart failure preserved ejection fraction (HFpEF), we utilized two-dimensional speckle tracking (2D-STI) stratified strain imaging. We retrospectively summarized 146 patients diagnosed with HFpEF in our hospital from January 2022 to January 2023. 2D-STI combined with stratified strain imaging was used to measure the overall left ventricular global longitudinal strain (LVGLS), the sub-endocardium, mid-myocardium, sub-epicardium LS of the left ventricle, as well as the basal, intermediate, and apical LS, the peak strain dispersion (PSD) and the transmural pressure difference, the postsystolic shortening (PSS), and early systolic lengthening. They were categorized into adverse and better prognosis groups based on major adverse cardiac events (MACE). MACE occurred in a total of 25 of 146 patients (17.12%). Compared with the better group (P < .05), there were significant differences in ages, incidences of myocardial infarction, pre-admission plasma brain natriuretic peptide levels, LVGLS, sub-endocardium and sub-epicardium LS, PSD, and PSS values in the adverse group. Compared to pretreatment in the better group at 1-month follow-up, LVGLS, sub-endocardium, mid-level, sub-epicardium LS, PSD, and PSS values improved significantly (P < .05), but the adverse group did not (P > .05). Multivariate Cox regression demonstrated that pretreatment LVGLS (HR = 1.362, 95% CI = 1.026-1.809, P = .033), sub-epicardium LS (HR = 1.669, 95% CI = 1.068-2.609, P = .025), and PSD values (HR = 1.075, 95% CI = 1.014-1.140, P = .015) were important predictors of the occurrence of MACE in patients with HFpEF. The receiver operating curves manifested that the area under the curve of pretreatment LVGLS, sub-epicardium LS, and PSD values for predicting the occurrence of MACE were 0.812 (95% CI = 0.730-0.894, P < .001), 0.847 (95% CI = 0.775-0.919, P < .001), and 0.924 (95% CI = 0.863-0.984, P < .001). 2D-STI combined with stratified strain imaging can provide a more comprehensive, objective, and accurate assessment of myocardial synchronized exercise and clinical prognosis in patients with HFpEF, and LVGLS, sub-epicardium LS, and PSD values can be used in clinical practice as noninvasive, sensitive indicators for predicting the occurrence of MACE.
为评估射血分数保留的心力衰竭（HFpEF）患者的心肌同步运动及临床预后，我们采用二维斑点追踪（2D-STI）分层应变成像技术。我们回顾性总结了2022年1月至2023年1月在我院确诊为HFpEF的146例患者。使用2D-STI结合分层应变成像测量左心室整体纵向应变（LVGLS）、左心室心内膜下、心肌中层、心外膜下应变，以及基底、中间和心尖应变、峰值应变离散度（PSD）和跨壁压差、收缩后缩短（PSS）和收缩早期延长。根据主要不良心脏事件（MACE）将患者分为不良预后组和较好预后组。146例患者中共有25例（17.12%）发生MACE。与较好组相比（P < 0.05），不良组在年龄、心肌梗死发生率、入院前血浆脑钠肽水平、LVGLS、心内膜下和心外膜下应变、PSD及PSS值方面存在显著差异。与较好组1个月随访时相比，较好组的LVGLS、心内膜下、中层、心外膜下应变、PSD及PSS值有显著改善（P < 0.05），但不良组未改善（P > 0.05）。多因素Cox回归显示，预处理时的LVGLS（HR = 1.362，95%CI = 1.026 - 1.809，P = 0.033）、心外膜下应变（HR = 1.669，95%CI = 1.068 - 2.609，P = 0.025）和PSD值（HR = 1.075，95%CI = 1.014 - 1.140，P = 0.015）是HFpEF患者发生MACE的重要预测因素。受试者工作曲线表明，预处理时LVGLS、心外膜下应变和PSD值预测MACE发生的曲线下面积分别为0.812（95%CI = 0.730 - 0.894，P < （此处原文有误，推测应该是P < 0.001））、0.847（95%CI = 0.775 - 0.919，P < 0.001）和0.9（此处原文有误，推测应该是0.924）（95%CI = 0.863 - 0.984，P < 0.001）。2D-STI结合分层应变成像可为HFpEF患者的心肌同步运动及临床预后提供更全面、客观和准确的评估，LVGLS、心外膜下应变和PSD值可作为临床实践中预测MACE发生的无创、敏感指标。
