OBJECTIVES This study investigated the prognostic utility of left ventricular (LV) untwisting (UT) in the elderly patients at risk of heart failure (HF). BACKGROUND LV UT mechanics represent a unique combination of LV filling linking ventricular relaxation and suction. The value of this parameter in the prediction of outcomes in patients at risk of HF is unclear. METHODS A group of 465 asymptomatic subjects ≥65 years of age with ≥1 HF risk factor (hypertension, diabetes, obesity), recruited from the community, underwent clinical evaluation and echocardiography including measurement of LV apical and basal peak UT velocities. Cox regression analysis was used to identify predictors of new-onset HF and cardiovascular death after a mean follow-up of 18.2 ± 7.5 months. RESULTS A composite of both of the study endpoints occurred in 54 patients (11.6%). Adverse outcome was significantly associated with apical (hazard ratio [HR]: 0.98; 95% confidence interval [CI]: 0.96 to 0.99; p = 0.006) UT but not with basal (p = 0.18) UT. The prognostic value of apical UT was independent of and incremental to clinical data, as expressed by the ARIC (Atherosclerosis Risk In Communities) study risk score, left atrial volume index (LAVI), and LV global longitudinal strain (GLS). The addition of apical UT to the model including ARIC risk score, LAVI, and GLS was associated with a 41% improvement in reclassification (p = 0.006). CONCLUSIONS Echocardiographic assessment of apical UT provides incremental value in predicting adverse outcome in asymptomatic patients with HF risk factors. The inclusion of apical UT to the diagnostic algorithm may improve the prognostication process in this population.

中文翻译：

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有心衰危险因素的无症状患者心房颤动减少与根尖扭转的关系。

目的这项研究调查了左心室（LV）扭转（UT）对有心力衰竭（HF）风险的老年患者的预后效用。背景技术LV UT力学代表了连接心室舒张和吸力的LV充盈的独特组合。该参数在HF风险患者的预后预测中的价值尚不清楚。方法从社区招募了465名≥65岁，HF危险因素≥1（高血压，糖尿病，肥胖）的无症状受试者，对他们进行了临床评估和超声心动图检查，包括测量LV根尖和基础UT峰值速度。在平均随访18.2±7.5个月后，使用Cox回归分析确定新发HF和心血管死亡的预测指标。结果54个患者（11.6％）出现了这两个研究终点的复合物。不良结局与心尖（危险比[HR]：0.98； 95％置信区间[CI]：0.96至0.99； p = 0.006）显着相关，而与基础（p = 0.18）UT无关。如ARIC（社区动脉粥样硬化风险）研究风险评分，左心房容积指数（LAVI）和LV总体纵向应变（GLS）所示，根尖UT的预后价值与临床数据无关，且随临床数据的增加。向模型中添加顶端UT（包括ARIC风险评分，LAVI和GLS）与重新分类改善41％（p = 0.006）有关。结论超声心动图评估心尖部超声可为无症状心衰危险因素的无症状患者预测不良结果提供增量价值。在诊断算法中包括根尖UT可以改善该人群的预后过程。