Rodriguez-Sanchez Ibon, Villanueva-Benito Inaki, Agirre Urko, Onaindia Jose Juan, Urkullu Alazne, Cacicedo Angela, Ullate Alberto, Bravo Idoia, Florido Josu, Salcedo Alberto, Velasco Sonia
Department of Cardiology, Galdakao University Hospital, Biobizkaia Health Research Institute, Osakidetza, Spain.
Department of Cardiology, Donostia University Hospital, Biodonostia Health Research Institute, Osakidetza, Spain.
Front Cardiovasc Med. 2025 Jul 9;12:1565052. doi: 10.3389/fcvm.2025.1565052. eCollection 2025.
A limited number of studies have examined the prognostic significance of diastolic function in patients with preserved left ventricular ejection fraction (LVEF) in a general population referred for transthoracic echocardiography. Our aim was to assess the association between diastolic function and a combined event in which the left atrium plays a pivotal role, including heart failure (HF), atrial fibrillation (AF) and ischemic stroke. The study sought to determine the incremental value of left atrial reservoir strain (LARS) in risk stratification.
We performed a retrospective analysis of 364 patients with preserved LVEF and sinus rhythm referred for transthoracic echocardiography and categorized them into four groups based on their diastolic function status according to the 2016 ASE/EACVI guidelines: normal diastolic function (NDF), indeterminate diastolic function and diastolic dysfunction with indeterminate filling pressure (IDT), grade 1 diastolic dysfunction (DD1), and diastolic dysfunction with elevated filling pressure (DD-EFP). The primary endpoint was a composite of HF, AF or ischemic stroke. LARS was measured by 2D speckle tracking. Clinical parameters, comorbidities and specific cardiac diseases were also assessed. Secondary endpoint was all-cause mortality.
The mean follow-up period was 2.4 years. IDT and DD-EFP diastolic function status were independently associated with the combined event. The incorporation of LARS enhanced risk stratification, particularly in IDT patients, with a cutoff of ≤24% identifying a high-risk population. Patients classified as high risk, defined as those with DD-EFP and IDT with LARS ≤ 24%, exhibited a notable event rate of 34% and 46%, respectively. Diastolic function and LARS were not independently associated with all-cause mortality.
In patients with preserved LVEF and sinus rhythm, diastolic function is strongly and independently associated with the combined event of HF, AF, or ischemic stroke. LARS provides a valuable tool for improving risk stratification in this population. Patients at high risk (DD-EFP and IDT with LARS ≤ 24%) demonstrated a significant event rate, underscoring the necessity for preventive measures. Diastolic function and LARS were not independently associated with all-cause mortality. Further studies are required to confirm these findings and validate the proposed approach.
在因经胸超声心动图检查而就诊的普通人群中，仅有少数研究探讨了左心室射血分数（LVEF）保留患者舒张功能的预后意义。我们的目的是评估舒张功能与包括心力衰竭（HF）、心房颤动（AF）和缺血性卒中在内的、左心房起关键作用的联合事件之间的关联。该研究旨在确定左心房储备应变（LARS）在风险分层中的增量价值。
我们对364例LVEF保留且为窦性心律、因经胸超声心动图检查而就诊的患者进行了回顾性分析，并根据2016年美国超声心动图学会/欧洲心血管影像学会（ASE/EACVI）指南，依据舒张功能状态将他们分为四组：舒张功能正常（NDF）、舒张功能不确定和充盈压不确定的舒张功能障碍（IDT）、1级舒张功能障碍（DD1）以及充盈压升高的舒张功能障碍（DD-EFP）。主要终点是HF、AF或缺血性卒中的复合事件。LARS通过二维斑点追踪测量。还评估了临床参数、合并症和特定的心脏疾病。次要终点是全因死亡率。
平均随访期为2.4年。IDT和DD-EFP舒张功能状态与联合事件独立相关。纳入LARS可增强风险分层，尤其是在IDT患者中，以≤24%为临界值可识别出高危人群。被归类为高危的患者，即DD-EFP和LARS≤24%的IDT患者，分别表现出显著的事件发生率，即34%和46%。舒张功能和LARS与全因死亡率无独立关联。
在LVEF保留且为窦性心律的患者中，舒张功能与HF、AF或缺血性卒中的联合事件密切且独立相关。LARS为改善该人群的风险分层提供了一个有价值的工具。高危患者（DD-EFP和LARS≤24%的IDT患者）表现出显著的事件发生率，强调了采取预防措施的必要性。舒张功能和LARS与全因死亡率无独立关联。需要进一步研究来证实这些发现并验证所提出的方法。
