Prognostic significance of longitudinal strain in dilated cardiomyopathy with recovered ejection fraction.
Prognostic significance of longitudinal strain in dilated cardiomyopathy with recovered ejection fraction.
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DOI：
10.1136/heartjnl-2021-319504
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发表时间：
2022-05
期刊：
影响因子：
--
通讯作者：
Adamo L
中科院分区：
文献类型：
--
作者：
Merlo M;Masè M;Perry A;La Franca E;Deych E;Ajello L;Bellavia D;Boscutti A;Gobbo M;Romano G;Stolfo D;Gorcsan J;Clemenza F;Sinagra G;Adamo L
非缺血性扩张型心肌病(NICM)患者的左心室射血分数可能恢复正常。虽然这与预后的改善有关，但并不对应于随访期间死亡风险的正常化。目前，还没有工具来对这一人群进行风险分层。我们验证了绝对全球纵向应变(AGLS)与NICM患者死亡率和恢复射血分数(LVEF)相关的假设。我们设计了一项前瞻性、国际性、纵向队列研究，纳入LVEF和lt；40%改善到正常范围(>；50%)的NICM患者。我们研究了在第一次记录标准化左心室射血分数时测量的AGL与随访期间全因死亡率之间的关系。我们认为AGLS和GT；18%为正常，AGLS≥为16%具有潜在的预后价值。206名患者符合纳入标准。中位年龄为53.5岁(四分位数范围：44.3，62.8)，其中56.6%为男性。诊断时LVEF为32.0%(IQR：24.0~38.8)。恢复时左心室射血分数为55.0%(IQR：51.7~60.0)。LVEF恢复时AGLS为13.6±3.9%。16 6例(80%)和14 1例(68%)患者的AGLS≤分别为18%和16%。随访5.5±2.8年，死亡35例(17%)。首次记录恢复的左心室射血分数时的AGL与随访期间的死亡率相关(在调整的COX模型中，HR0.90，95%CI0.91~0.99，p=0.048)。在AGL正常的患者中没有观察到死亡(>；18%)。在未经调整的卡普兰-迈耶生存分析中，AGLS<；16%与随访期间较高的死亡率(GLS<患者中31例死亡(22%)；≥患者中4例死亡[6.2%])有关联。在NICM和LVEF正常的患者中，在LVEF恢复时AGLS受损是常见的，并与较差的预后相关。
Patients with Non-Ischemic Dilated Cardiomyopathy (NICM) may experience a normalization in LVEF. Although this correlates with improved prognosis, it doesn’t correspond to a normalization in the risk of death during follow-up. Currently, there are no tools to risk stratify this population. We tested the hypothesis that absolute global longitudinal strain (aGLS) is associated with mortality in patients with NICM and recovered ejection fraction (LVEF). We designed a retrospective, international, longitudinal cohort study enrolling NICM patients with LVEF <40% improved to the normal range (>50%). We studied the relationship between aGLS measured at the time of the first recording of a normalized LVEF and all-cause mortality during follow-up. We considered aGLS>18% as normal and aGLS≥16% as of potential prognostic value. 206 patients met inclusion criteria. Median age was 53.5 years (Inter Quartile Range - IQR: 44.3, 62.8) and 56.6% were males. LVEF at diagnosis was 32.0%, (IQR: 24.0-38.8). LVEF at the time of recovery was 55.0% (IQR: 51.7-60.0). aGLS at the time of LVEF recovery was 13.6±3.9%. 166 (80%) and 141 (68%) patients had aGLS ≤18% and <16%, respectively. During a follow-up of 5.5±2.8 years, 35 patients (17%) died. aGLS at the time of first recording of a recovered LVEF correlated with mortality during follow up (HR 0.90, 95% CI 0.91-0.99, p=0.048 in adjusted Cox model). No deaths were observed in patients with normal aGLS (>18%). In unadjusted Kaplan-Meyer survival analysis, aGLS <16% was associated with higher mortality during follow-up (31 deaths [22 %] in patients with GLS<16% vs. 4 deaths [6.2 %] in patients with GLS≥16%, Hazard Ratio 3.2, 95% CI 1.1-9, p= 0.03. In patients with NICM and normalized LVEF, an impaired aGLS at the time of LVEF recovery is frequent and associated with worse outcomes.
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影响因子：
39.3
作者：
Smiseth OA;Torp H;Opdahl A;Haugaa KH;Urheim S
通讯作者：
Urheim S
DOI：
10.1016/s0735-1097(01)01738-7
发表时间：
2002-01-16
影响因子：
24
作者：
Felker, GM;Shaw, LK;O'Connor, CM
通讯作者：
O'Connor, CM
DOI：
10.1016/j.echo.2019.08.012
发表时间：
2019-11-01
影响因子：
6.5
作者：
Asch, Federico M.;Miyoshi, Tatsuya;Schreckenberg, Marcus
通讯作者：
Schreckenberg, Marcus
影响因子：
18.2
作者：
Merlo, Marco;Cannata, Antonio;Sinagra, Gianfranco
通讯作者：
Sinagra, Gianfranco
影响因子：
5.7
作者：
Chimura, Misato;Onishi, Tetsuari;Kawai, Hiroya
通讯作者：
Kawai, Hiroya