Ratio of transmitral early filling velocity to early diastolic strain rate predicts long-term risk of cardiovascular morbidity and mortality in the general population
Ratio of transmitral early filling velocity to early diastolic strain rate predicts long-term risk of cardiovascular morbidity and mortality in the general population
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DOI：
10.1093/eurheartj/ehy164
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发表时间：
2019-02-07
影响因子：
39.3
通讯作者：
Biering-Sorensen, Tor
中科院分区：
文献类型：
--
作者：
Lassen, Mats Christian Hojbjerg;Biering-Sorensen, Sofie Reumert;Biering-Sorensen, Tor
目的：以前已经证明，早期二尖瓣血流速度与整体舒张期应变率（E/e 'sr）的比值是特定患者人群心脏事件的重要预测因子。该测量的效用，以预测在一般人群中的心血管事件尚未evaluated.Methods和结果A在一般人群中的研究，共1238名参与者进行了健康检查，包括超声心动图，其中全球纵向应变（GLS）和E/e 'SR被确定。主要终点是心力衰竭（HF）、急性心肌梗死（AMI）或心血管死亡（CVD）的复合终点。在随访期间（中位数11年），140名（11.3%）参与者达到复合终点。E/e 'sr与不良结局相关[HR 1.17 95%CI（1.13-1.21）; P < 0.001，每增加10 cm]。在对超声心动图和临床参数进行多变量调整后，与E/e' [HR 1.03，95% CI（0.99-1.06）;每增加1个单位P = 0.11]相比，E/e' sr仍然是复合终点的独立预测因子[HR 1.08，95% CI（1.02-1.13）; P = 0.003]。整体纵向应变改变了E/e 'sr和结果之间的关系（相互作用P = 0.015）。在GLS确定的收缩功能良好的参与者中，E/e 'sr是一个更强的预测因子与收缩功能降低的参与者相比，多变量调整后（GLS > 18%）（GLS < 18%）[HR 1.28 95% CI（1.06-1.54）; P = 0.011和HR 1.08 95% CI（1.02-1.14）; P = 0.012）。E/e 'sr提供了超出SCORE风险图的增量信息[Harrell's C-index：0.839（0.81-0.87）vs.0.844（0.82-0.87）; P = 0.045]。结论在一般人群中，E/e' sr提供了关于心血管发病率和死亡率的独立和增量预后信息。此外，E/e 'sr是比E/e'更强的心脏事件预测因子。
Aims It has previously been demonstrated that the ratio of early mitral inflow velocity to global diastolic strain rate (E/e'sr) is a significant predictor of cardiac events in specific patient populations. The utility of this measurement to predict cardiovascular events in a general population has not been evaluated.Methods and results A total of 1238 participants in a general population study underwent a health examination including echocardiography where global longitudinal strain (GLS) and E/e'sr were determined. The primary endpoint was the composite of incident heart failure (HF), acute myocardial infarction (AMI) or cardiovascular death (CVD). During follow-up (median 11 years), 140 (11.3%) participants reached the composite endpoint. E/e'sr was associated with adverse outcome [HR 1.17 95% CI (1.13-1.21); P < 0.001, per 10 cm increase]. After multivariable adjustment for echocardiographic and clinical parameters, E/e'sr remained an independent predictor of the composite endpoint [HR 1.08, 95% CI (1.02-1.13); P = 0.003] as opposed to E/e' [HR 1.03, 95% CI (0.99-1.06); P = 0.11 per 1 unit increase]. Global longitudinal strain modified the relationship between E/e'sr and outcome (P for interaction = 0.015). E/e'sr was a stronger predictor in participants with good systolic function as determined by GLS (GLS > 18%) after multivariable adjustment, when compared to participants with reduced systolic function (GLS < 18%) [HR 1.28 95% CI (1.06-1.54); P = 0.011, and HR 1.08 95% CI (1.02-1.14); P = 0.012, respectively). E/e'sr provided incremental information [Harrell's C-index: 0.839 (0.81-0.87) vs. 0.844 (0.82-0.87); P = 0.045] beyond the SCORE risk chart.Conclusion In the general population, E/e'sr provides independent and incremental prognostic information regarding cardiovascular morbidity and mortality. Additionally, E/e'sr is a stronger predictor of cardiac events than E/e'.