Objectives This study hypothesized that left ventricular (LV) ejection fraction (EF) and global longitudinal strain (GLS) derived from 3-dimensional echocardiographic (3DE) images would better predict mortality than those obtained by 2-dimensional echocardiographic (2DE) measurements, and that 3DE-based LV shape analysis may have added prognostic value.

Background Previous studies have shown that both LVEF and GLS derived from 2DE images predict mortality. Recently, 3DE measurements of these parameters were found to be more accurate and reproducible because of independence of imaging plane and geometric assumptions. Also, 3DE analysis offers an opportunity to accurately quantify LV shape.

Methods We retrospectively studied 416 inpatients (60 ± 18 years of age) referred for transthoracic echocardiography between 2006 and 2010, who had good-quality 2DE and 3DE images were available. Mortality data through 2016 were collected. Both 2DE and 3DE images were analyzed to measure LVEF and GLS. Additionally, 3DE-derived LV endocardial surface information was analyzed to obtain global shape indices (sphericity and conicity) and regional curvature (anterior, septal, inferior, lateral walls). Cardiovascular (CV) mortality risks related to these indices were determined using Cox regression.

Results Of the 416 patients, 208 (50%) died, including 114 (27%) CV-related deaths over a mean follow-up period of 5 ± 3 years. Cox regression revealed that age and body surface area, all 4 LV function indices (2D EF, 3D EF, 2D GLS, 3D GLS), and regional shape indices (septal and inferior wall curvatures) were independently associated with increased risk of CV mortality. GLS was the strongest prognosticator of CV mortality, superior to EF for both 2DE and 3DE analyses, and 2D EF was the weakest among the 4 functional indices. A 1% decrease in GLS magnitude was associated with an 11.3% increase in CV mortality risk.

Conclusions GLS predicts mortality better than EF by both 3DE and 2DE analysis, whereas 3D EF is a better predictor than 2D EF. Also, LV shape indices provide additional risk assessment.

目的本研究假设从3维超声心动图（3DE）图像得出的左心室射血分数（EF）和整体纵向应变（GLS）可以比二维超声心动图（2DE）测量获得的死亡率更好地预测死亡率，并且基于3DE的LV形状分析可能增加了预后价值。

背景技术先前的研究表明，从2DE图像获得的LVEF和GLS均可预测死亡率。最近，由于成像平面和几何假设的独立性，发现这些参数的3DE测量更加准确和可重复。同样，3DE分析提供了准确量化左心室形状的机会。

方法我们回顾性研究了2006年至2010年间经胸超声心动图检查的416例住院患者（60±18岁），他们均具有高质量的2DE和3DE图像。收集了截至2016年的死亡率数据。分析2DE和3DE图像以测量LVEF和GLS。此外，分析了3DE衍生的LV心内膜表面信息，以获得整体形状指数（球形和圆锥形）和区域曲率（前，中隔，下壁，侧壁）。使用Cox回归确定与这些指数相关的心血管（CV）死亡风险。

结果在416例患者中，平均随访时间为5±3年，其中208例（50％）死亡，包括114例（27％）与心血管相关的死亡。Cox回归显示，年龄和体表面积，所有4个LV功能指数（2D EF，3D EF，2D GLS，3D GLS）和区域形状指数（中隔壁和下壁曲率）均与CV死亡风险增加相关。在2DE和3DE分析中，GLS是CV死亡率最强的预后因子，优于EF，在4个功能指标中，二维EF最弱。GLS量级降低1％与CV死亡风险增加11.3％相关。

结论通过3DE和2DE分析，GLS预测死亡率优于EF，而3D EF比2D EF更好。此外，LV形状指数还提供了其他风险评估。