Objectives

Because diastolic late mitral annular velocity (a') obtained by transthoracic-echocardiography (TTE) represents left atrial (LA) function, we investigated the clinical significance of a' in heart failure (HF) with a preserved left ventricular (LV) ejection fraction (HFpEF).

Methods

We enrolled 448 consecutive HFpEF patients (sinus rhythm: 66.3%, atrial fibrillation [AF] rhythm: 33.7%) and performed TTE under stable conditions after optimal therapy. In patients with sinus rhythm, a' values were measured at septal mitral annuli.

Results

A' had weak but significant negative correlations with the natural-logarithm-B-type natriuretic peptide (Ln-BNP), LA diameter, LV mass index and tricuspid regurgitation pressure gradient. Receiver operating characteristic (ROC) curve analysis showed that the best cut-off value of a' and systolic mitral annular velocity (s') for the prediction of HF-related events were 7.45 cm/s and 6.5 cm/s with areas under the curve (AUC) of 0.841 and 0.682, respectively. The AUC of ROC analysis for the logistic regression model of a' plus s' was improved to 0.97. In Kaplan-Meier analysis, HFpEF patients with low-a' (<7.45 cm/s) had a significantly higher risk of total cardiovascular and HF-related events (both p < .01 by log-rank test) than those with high-a' (≥ 7.45 cm/s) and were prognostically equivalent to those with AF. Multivariate Cox proportional hazard analysis identified low-a' as an independent predictor of both total cardiovascular (hazard ratio [HR]: 0.823, 95% confidence interval [CI]: 0.714–0.949, p = .007) and HF-related events (HR: 0.551, 95% CI: 0.422–0.720, p < .001).

Conclusion

A' value measurement is a non-invasive and useful method for risk stratification in HFpEF.

中文翻译：

---

保留射血分数的心力衰竭舒张末期二尖瓣环速度的临床意义。

目标

由于经胸超声心动图（TTE）获得的舒张末期二尖瓣环速度（a'）代表左心房（LA）功能，因此我们研究了保留左心室（LV）射血分数的a'在心力衰竭（HF）中的临床意义（HFpEF）。

方法

我们招募了448例连续的HFpEF患者（窦律：66.3％，房颤[AF]律：33.7％），并在最佳治疗后在稳定的条件下进行TTE。在窦性心律患者中，在二尖瓣隔间隔测量a'值。

结果

A'与自然对数B型利尿钠肽（Ln-BNP），LA直径，LV质量指数和三尖瓣返流压力梯度呈弱但显着的负相关。接收器工作特性（ROC）曲线分析显示，用于预测与HF相关的事件的a'和收缩期二尖瓣环速度（s'）的最佳截止值为7.45 cm / s和6.5 cm / s，且区域低于曲线（AUC）分别为0.841和0.682。将a'加s'的逻辑回归模型的ROC分析的AUC提高到0.97。在Kaplan-Meier分析中，低a'（<7.45 cm / s）的HFpEF患者发生总心血管和HF相关事件的风险显着更高（均p 对数秩检验<0.01）大于高a'（≥7.45 cm / s）的患者，并且在预后上与AF患者相同。多元Cox比例风险分析确定低a'是总心血管事件（风险比[HR]：0.823、95％置信区间[CI]：0.714-0.949，p  = .007）和HF相关事件的独立预测因子（ HR：0.551，95％CI：0.422–0.720，p  <.001）。

结论

A'值测量是用于HFpEF中风险分层的一种非侵入性且有用的方法。