JACC: Heart Failure ( IF 10.3 ) Pub Date : 2021-11-10 , DOI: 10.1016/j.jchf.2021.08.007 Satit Janwanishstaporn 1 , Jae Yeong Cho 2 , Siting Feng 3 , Alison Brann 4 , Jeong-Sook Seo 5 , Anna Narezkina 4 , Barry Greenberg 4
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Objectives
The authors sought to determine whether global longitudinal strain (GLS) is independently associated with the natural history of patients with heart failure (HF) with improved ejection fraction (HFimpEF).
Background
Left ventricular (LV) ejection fraction (EF) often improves in patients with reduced EF. The clinical course of patients with HFimpEF, however, is quite variable. GLS, a sensitive indicator of LV systolic function, could help predict risk of future events in this population.
Methods
Retrospective analysis of HF patients with LVEF >40% on index echocardiogram who had LVEF <40% on initial study and improvement of ≥10%. GLS was assessed by 2-dimensional speckle-tracking software on index echocardiography. Primary outcome was time to first occurrence of cardiovascular mortality or HF hospitalization/emergency treatment.
Results
Of the 289 patients with HFimpEF, median absolute values of GLS (aGLS) and LVEF from index echocardiography were 12.7% (IQR: 10.8%-14.7%) and 52% (IQR: 46%-58%), respectively. Over 53 months following index echocardiography, the primary endpoint occurred less frequently in patients with aGLS above the median than below it (21% vs 34%; P = 0.014); HR of 0.51; 95% CI: 0.33-0.81; P = 0.004. When assessed as a continuous variable, each 1% increase in aGLS on index echocardiogram was associated with a lower likelihood of the composite endpoint; HR of 0.86; 95% CI: 0.79-0.93; P < 0.001, an association that persisted after multivariable adjustment; HR 0.90; 95% CI: 0.82-0.97; P = 0.01. Lower aGLS was associated with increased likelihood of deterioration in LVEF.
Conclusions
In patients with HFimpEF, GLS is a strong predictor for future HF events and deterioration in cardiac function.
中文翻译：
射血分数提高的心力衰竭患者整体纵向应变的预后价值
目标
作者试图确定整体纵向应变 (GLS) 是否与射血分数改善 (HFimpEF) 的心力衰竭 (HF) 患者的自然病程独立相关。
背景
左心室 (LV) 射血分数 (EF) 通常会在 EF 降低的患者中得到改善。然而，HFimpEF 患者的临床病程变化很大。GLS 是 LV 收缩功能的敏感指标，可以帮助预测该人群未来事件的风险。
方法
对指数超声心动图显示 LVEF > 40% 且在初始研究中 LVEF <40% 且改善≥10% 的 HF 患者的回顾性分析。GLS 是通过二维散斑跟踪软件在指数超声心动图上进行评估的。主要结果是首次发生心血管死亡或心衰住院/紧急治疗的时间。
结果
在 289 名 HFimpEF 患者中，指数超声心动图的 GLS (aGLS) 和 LVEF 中位绝对值分别为 12.7% (IQR: 10.8%-14.7%) 和 52% (IQR: 46%-58%)。在指数超声心动图后 53 个月内，aGLS 高于中位数的患者发生主要终点的频率低于低于中位数的患者（21% 对 34%；P = 0.014）；人力资源为 0.51；95% CI：0.33-0.81；P = 0.004。当评估为连续变量时，指数超声心动图上 aGLS 每增加 1% 与复合终点的可能性降低相关；人力资源为 0.86；95% CI：0.79-0.93；P < 0.001，多变量调整后持续存在的关联；人力资源 0.90；95% CI：0.82-0.97；P =0.01。较低的 aGLS 与 LVEF 恶化的可能性增加有关。
结论
在 HFimpEF 患者中，GLS 是未来 HF 事件和心功能恶化的强有力预测因子。
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