Hirose Kazutoshi, Nakanishi Koki, Daimon Masao, Seki Hikari, Yoshida Yuriko, Hirokawa Megumi, Nakao Tomoko, Kimura Koichi, Minatsuki Shun, Hatano Masaru, Morita Hiroyuki, Di Tullio Marco R, Homma Shunichi, Kurano Makoto, Takeda Norihiko
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Department of Clinical Laboratory, The University of Tokyo, Tokyo, Japan.
CJC Open. 2025 Feb 13;7(8):1132-1139. doi: 10.1016/j.cjco.2025.02.006. eCollection 2025 Aug.
Left atrial (LA) reservoir strain (LARS) is emerging as an early marker of cardiac remodelling, providing significant prognostic information. The present study investigated the prevalence of LA dysfunction and its association with pulmonary hemodynamics and cardiovascular (CV) outcomes in systemic sclerosis (SSc) patients.
We included 52 patients who had SSc without structural cardiac disease. All patients underwent 2-dimensional transthoracic echocardiography and right heart catheterization. LARS was assessed by using speckle-tracking analysis. The study outcome was a composite of heart failure or pulmonary hypertension (PH)-related hospitalization, lung transplantation, and CV death.
Abnormal LARS (< 24%) was present in 18 patients (34.6%). Despite the similar prevalence of PH between groups with abnormal vs normal LARS ( = 0.322), patients with LA dysfunction had significantly higher pulmonary vascular resistance (3.5 Wood Units [1.9-5.2] vs 2.0 Wood Units [1.3-2.9], = 0.029) and reduced pulmonary artery compliance (2.4 [2.1-4.1] ml/mm Hg vs. 3.9 [2.5-5.0] ml/mm Hg, p=0.024) than those with normal LARS. During a median follow-up of 3.2 years, patients with LA dysfunction displayed worse event-free survival than their counterparts (log-rank = 0.036). The combination of LA function and PH status provided better risk stratification for composite CV outcome, as the highest incidence of adverse outcome was observed in patients with LA dysfunction and PH (40.0%), followed by those with LA dysfunction or PH alone (13.6%), and finally those without LA dysfunction and PH (0%, = 0.008).
LA dysfunction was related to unfavourable pulmonary artery remodelling and adverse outcomes in SSc patients without structural cardiac disease.
左心房（LA）储备应变（LARS）正逐渐成为心脏重塑的早期标志物，可提供重要的预后信息。本研究调查了系统性硬化症（SSc）患者左心房功能障碍的患病率及其与肺血流动力学和心血管（CV）结局的关联。
我们纳入了52例无结构性心脏病的SSc患者。所有患者均接受二维经胸超声心动图检查和右心导管检查。采用斑点追踪分析评估LARS。研究结局为心力衰竭或肺动脉高压（PH）相关住院、肺移植和CV死亡的综合情况。
18例患者（34.6%）存在LARS异常（<24%）。尽管LARS异常组与正常组的PH患病率相似（P = 0.322），但与LARS正常的患者相比，左心房功能障碍患者的肺血管阻力显著更高（3.5伍德单位[1.9 - 5.2] vs 2.0伍德单位[1.3 - 2.9]，P = 0.029），肺动脉顺应性降低（2.4[2.1 - 4.1]ml/mm Hg vs. 3.9[2.5 - 5.0]ml/mm Hg，P = 0.024）。在中位随访3.2年期间，左心房功能障碍患者的无事件生存率低于对照组（对数秩检验P = 0.036）。左心房功能和PH状态的联合可为复合CV结局提供更好的风险分层，因为在左心房功能障碍合并PH的患者中观察到不良结局的发生率最高（40.0%），其次是单独存在左心房功能障碍或PH的患者（13.6%），最后是无左心房功能障碍和PH的患者（0%，P = 0.008）。
在无结构性心脏病的SSc患者中，左心房功能障碍与不良的肺动脉重塑和不良结局相关。
