Prediction of All-Cause Mortality and Heart Failure Admissions From Global Left Ventricular Longitudinal Strain in Patients With Acute Myocardial Infarction and Preserved Left Ventricular Ejection Fraction
Prediction of All-Cause Mortality and Heart Failure Admissions From Global Left Ventricular Longitudinal Strain in Patients With Acute Myocardial Infarction and Preserved Left Ventricular Ejection Fraction
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DOI：
10.1016/j.jacc.2013.02.061
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发表时间：
2013-06-11
影响因子：
24
通讯作者：
Kober, Lars
中科院分区：
文献类型：
--
作者：
Ersboll, Mads;Valeur, Nana;Kober, Lars
目的：本研究旨在验证一种假设，即半自动计算左心室总纵向应变（GLS）可以在左心室射血分数（LVEFs）低于40%的心肌梗死（MIs）患者中识别出高风险受试者。背景LVEF是急性心肌梗死后决策的关键决定因素，但在正常范围内相对不明显。新的超声心动图变形参数可能是特别的临床相关性患者相对保存的左心室内皮细胞。方法前瞻性纳入入院48 h内心肌梗死和低血管内皮细胞密度达40%的患者。所有患者均行超声心动图，半自动测量GLS。使用Cox回归分析主要复合终点（全因死亡率和心力衰竭住院）。次要终点为心源性死亡和心力衰竭住院。结果共纳入849例患者（平均年龄61.9±12.0岁，73%为男性），57例（6.7%）达到主要终点（中位随访30个月）。GLS具有显著的预后价值（风险比[HR]: 1.20； 95%可信区间[CI]: 1.10 ~ 1.32; p < 0.001）。GLS > -14%与联合终点的风险增加3倍相关（HR: 3.21; 95% CI: 1.82至5.67;p < 0.001）。在校正其他变量后，GLS仍然与联合终点独立相关（HR: 1.14; 95% CI: 1.04 ~ 1.26; p = 0.007）。对于次要终点，GLS > -14%与心血管死亡（HR: 12.7; 95% CI: 3.0 - 54.6; p < 0.001）和心力衰竭住院（HR: 5.31; 95% CI: 1.50 - 18.82; p < 0.001）显著相关。结论：使用半自动算法评估GLS可为LVEFs bb0 40%以上的高危心肌梗死患者提供重要的预后信息。(C) 2013年由美国心脏病学会基金会发布
Objectives This study sought to test the hypothesis that semiautomated calculation of left ventricular global longitudinal strain (GLS) can identify high-risk subjects among patients with myocardial infarctions (MIs) with left ventricular ejection fractions (LVEFs) >40%.Background LVEF is a key determinant in decision making after acute MI, yet it is relatively indiscriminant within the normal range. Novel echocardiographic deformation parameters may be of particular clinical relevance in patients with relatively preserved LVEFs.Methods Patients with MIs and LVEFs >40% within 48 h of admission for coronary angiography were prospectively included. All patients underwent echocardiography with semiautomated measurement of GLS. The primary composite endpoint (all-cause mortality and hospitalization for heart failure) was analyzed using Cox regression analyses. The secondary endpoints were cardiac death and heart failure hospitalization.Results A total of 849 patients (mean age 61.9 +/- 12.0 years, 73% men) were included, and 57 (6.7%) reached the primary endpoint (median follow-up 30 months). Significant prognostic value was found for GLS (hazard ratio [HR]: 1.20; 95% confidence interval [CI]: 1.10 to 1.32; p < 0.001). GLS > -14% was associated with a 3-fold increase in risk for the combined endpoint (HR: 3.21; 95% CI: 1.82 to 5.67; p < 0.001). After adjustment for other variables, GLS remained independently related to the combined endpoint (HR: 1.14; 95% CI: 1.04 to 1.26; p = 0.007). For the secondary endpoints, GLS > -14% was significantly associated with cardiovascular death (HR: 12.7; 95% CI: 3.0 to 54.6; p < 0.001) and heart failure hospitalization (HR: 5.31; 95% CI: 1.50 to 18.82; p < 0.001).Conclusions Assessment of GLS using a semiautomated algorithm provides important prognostic information in patients with LVEFs >40% above and beyond traditional indexes of high-risk MI. (C) 2013 by the American College of Cardiology Foundation