Association Between Myocardial Strain and Frailty in CHS.
Association Between Myocardial Strain and Frailty in CHS.
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DOI：
10.1161/circimaging.120.012116
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发表时间：
2021-05
期刊：
影响因子：
--
通讯作者：
Odden MC
中科院分区：
文献类型：
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作者：
Tan AX;Shah SJ;Sanders JL;Psaty BM;Wu C;Gardin JM;Peralta CA;Newman AB;Odden MC
斑点追踪超声心动图（STE）测量的心肌应变是亚临床心血管疾病（CVD）的一种新指标，可反映心肌老化。我们评估了心肌劳损和虚弱之间的关系，虚弱是一种缺乏生理储备的临床综合征。在心血管健康研究的参与者中，虚弱被定义为具有以下3个或更多个临床标准：虚弱、缓慢、体重减轻、疲惫和不活动。使用STE数据，我们检查了参与者中与虚弱的横截面（n= 3，206）和纵向（n= 1，431）相关性，这些参与者至少有一项心肌应变，左心室纵向应变（LVLS），左心室舒张早期应变率和左心房水库应变，并且在超声心动图检查时没有CVD或心力衰竭病史。在横断面分析中，较低（较差）的LVLS与普遍的虚弱相关;这种相关性在校正LV射血分数后是稳定的（校正OR：1.32，95% CI：1.07，1.61/1 SD下限应变，p=0.007）和LV每搏输出量（AOR：1.32，95%CI：1.08，每降低1 SD，1，61]菌株，p=0.007）。在纵向分析中，LVLS和LV舒张早期应变与偶发虚弱的校正相关性分别为：1.35（95% CI：0.96，1.89，p=0.086）和1.58（95% CI：1.11，2.27，p=0.013）。虚弱且LVLS最差的参与者死亡风险增加2.2倍（HR：2.20，95% CI：1.81，2.66，p<0.0001）。在社区居住的无心血管疾病的老年人中，STE的LVLS恶化，反映亚临床心肌功能障碍，与虚弱相关。虚弱和LVLS对死亡风险具有累加效应。
Myocardial strain, measured by speckle tracking echocardiography (STE), is a novel measure of subclinical cardiovascular disease (CVD) and may reflect myocardial aging. We evaluated the association between myocardial strain and frailty, a clinical syndrome of lack of physiologic reserve. Frailty was defined in participants of the Cardiovascular Health Study) as having 3 or more of the following clinical criteria: weakness, slowness, weight loss, exhaustion, and inactivity. Using STE data, we examined the cross-sectional (n=3,206) and longitudinal (n=1,431) associations with frailty among participants who had at least one measure of myocardial strain, left ventricular longitudinal strain (LVLS), LV early diastolic strain rate and left atrial reservoir strain, and no history of CVD or heart failure at the time of echocardiography. In cross-sectional analyses, lower (worse) LVLS was associated with prevalent frailty; this association was robust to adjustment for LV ejection fraction (adjusted OR: 1.32, 95% CI: 1.07, 1.61 per 1 SD lower strain, p=0.007) and LV stroke volume (AOR: 1.32, 95% CI: 1.08, 1,61 per 1 SD lower ] strain, p=0.007). In longitudinal analyses, adjusted associations of LVLS and LV early diastolic strain with incident frailty were: 1.35 (95% CI: 0.96, 1.89, p=0.086) and 1.58(95% CI: 1.11, 2.27, p=0.013 respectively). Participants who were frail and had the worst LVLS had a 2.2-fold increased risk of death (HR: 2.20, 95% CI: 1.81, 2.66, p<0.0001). In community-dwelling older adults without prevalent cardiovascular disease, worse LVLS by STE, reflective of subclinical myocardial dysfunction, was associated with frailty. Frailty and LVLS have an additive effect on mortality risk.