Prognostic Utility and Clinical Significance of Cardiac Mechanics in Heart Failure With Preserved Ejection Fraction: Importance of Left Atrial Strain.
Prognostic Utility and Clinical Significance of Cardiac Mechanics in Heart Failure With Preserved Ejection Fraction: Importance of Left Atrial Strain.
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DOI：
10.1161/circimaging.115.003754
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发表时间：
2016-03
期刊：
影响因子：
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通讯作者：
Shah SJ
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作者：
Freed BH;Daruwalla V;Cheng JY;Aguilar FG;Beussink L;Choi A;Klein DA;Dixon D;Baldridge A;Rasmussen-Torvik LJ;Maganti K;Shah SJ
左心房（LA）扩大与射血分数保留性心力衰竭（HFpEF）的不良事件相关。然而，LA力学的作用（即，LA应变措施）在HFpEF尚未得到很好的研究。我们假设，在HFpEF中，左心房应变降低（恶化）是一种关键的病理生理异常，与左心室（LV）或右心室（RV）纵向应变相比，与不良事件的相关性更强。我们评估了308例HFpEF患者的基线左心房功能，这些患者接受了纵向不良结局随访。所有患者均接受斑点追踪超声心动图测量左心室纵向应变，右心室游离壁应变，左心房增压器，管道和水库应变。通过回归分析评估LV、RV和LA应变测量的临床和预后意义。平均年龄为65±13岁; 64%为女性; 26%患有房颤;大多数（67%）患者存在左心房扩大。LA储层应变降低与肺血管阻力增加（P<0.0001）和峰值耗氧量降低（P=0.0001）相关。在LV、RV和LA应变测量中，LA储层应变是不良事件的最强相关性，并且与心血管住院或死亡的复合结局独立相关（LA应变每1 SD下降调整的HR = 1.54; 95%CI = 1.15-2.07; P=0.006）。左心房力学（特别是左心房储层应变）的异常指标是HFpEF的强有力的临床和预后因素。卸载LA和/或增强LA功能可能是HFpEF未来重要的治疗靶点。URL：http://www.clinicaltrials.gov。唯一标识符：NCT 01030991。
Left atrial (LA) enlargement is associated with adverse events in heart failure with preserved ejection fraction (HFpEF). However, the role of LA mechanics (i.e., LA strain measures) in HFpEF has not been well studied. We hypothesized that in HFpEF, reduced (worse) LA strain is a key pathophysiologic abnormality and is a stronger correlate of adverse events than left ventricular (LV) or right ventricular (RV) longitudinal strain. We evaluated baseline LA function in 308 patients with HFpEF who were followed longitudinally for adverse outcomes. All patients underwent speckle-tracking echocardiography for measurement of LV longitudinal strain, RV free wall strain, and LA booster, conduit, and reservoir strains. The clinical and prognostic significance of LV, RV, and LA strain measures was assessed by regression analyses. The mean age was 65±13 years; 64% were female; 26% had atrial fibrillation; and LA enlargement was present in the majority (67%) of patients. Decreased LA reservoir strain was associated with increased pulmonary vascular resistance (P<0.0001) and decreased peak oxygen consumption (P=0.0001). Of the LV, RV, and LA strain measures, LA reservoir strain was the strongest correlate of adverse events, and was independently associated with the composite outcome of cardiovascular hospitalization or death (adjusted HR per 1-SD decrease in LA strain = 1.54; 95% CI = 1.15–2.07; P=0.006). Abnormal indices of LA mechanics (particularly LA reservoir strain) are powerful clinical and prognostic factors in HFpEF. Unloading the LA and/or augmentation of LA function may be important future therapeutic targets in HFpEF. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01030991.