- 作者：Morten Sengelø ; v ; MB&lowast ; ; jlm392@alumni.ku.dk" class="auth_mail" title="E-mail the corresponding author ; Peter Godsk Jø ; rgensen ; MD&lowast ; ; &dagger ; ; Jan Skov Jensen ; MD ; PhD ; DMSc&lowast ; ; &dagger ; ; Niels Eske Bruun ; MD ; DMSc&lowast ; ; &Dagger ; ; Flemming Javier Olsen ; MB&lowast ; ; Thomas Fritz-Hansen ; MD&lowast ; ; Kotaro Nochioka ; MD ; PhD§ ; ; Tor Biering-Sø ; rensen ; MD ; PhD&lowast ; ; &dagger ; ; § ;
- 关键词：echocardiography ; GLS ; prognosis ; risk stratification ; speckle tracking ; systolic function
- 刊名：JACC: Cardiovascular Imaging
- 出版年：2015
- 出版时间：December 2015
- 年：2015
- 卷：8
- 期：12
- 页码：1351-1359
- 全文大小：342 K
Background
Measurement of myocardial deformation by 2-dimensional speckle tracking echocardiography, specifically GLS, may be superior to conventional echocardiographic parameters, including left ventricular ejection fraction, in predicting all-cause mortality in HFrEF patients.
Methods
Transthoracic echocardiographic examinations were retrieved for 1,065 HFrEF patients admitted to a heart failure clinic. The echocardiographic images were analyzed, and conventional and novel echocardiographic parameters were obtained.
Results
Many of the conventional echocardiographic parameters proved to be predictors of mortality. However, GLS remained an independent predictor of mortality in the multivariable model after adjusting for age, sex, body mass index, total cholesterol, mean arterial pressure, heart rate, ischemic cardiomyopathy, percutaneous transluminal coronary angioplasty, coronary artery bypass graft surgery, noninsulin dependent diabetes mellitus, and conventional echocardiographic parameters (hazard ratio [HR]: 1.15; 95% confidence interval [CI]: 1.04 to 1.27; p = 0.008, per 1% decrease). No other echocardiographic parameter remained an independent predictor after adjusting for these variables. Furthermore, GLS had the highest C-statistics of all the echocardiographic parameters and added incremental prognostic value with a significant increase in the net reclassification improvement (p = 0.009). Atrial fibrillation (AF) modified the relationship between GLS and mortality (p value for interaction = 0.036); HR: 1.08 (95% CI: 0.97 to 1.19), p = 0.150 and HR: 1.22 (95% CI: 1.15 to 1.29), p < 0.001, per 1% decrease in GLS for patients with and without AF, respectively. Sex also modified the relationship between GLS and mortality (p value for interaction = 0.047); HR: 1.23 (95% CI: 1.16 to 1.30), p < 0.001 and HR: 1.09 (95% CI: 0.99 to 1.20), p = 0.083, per 1% decrease in GLS for men and women, respectively.
Conclusions
GLS is an independent predictor of all-cause mortality in HFrEF patients, especially in male patients without AF. Furthermore, GLS was a superior prognosticator compared with all other echocardiographic parameters.