在心力衰竭中,下临床的左心室功能障碍的临床含义与保存的喷射分数:帕拉贡-HF研究
Masatoshi Minamisawa1,2, Riccardo M Inciardi1,3, Brian Claggett1
1Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
European journal of heart failure
|February 19, 2024
概括
通过全球纵向应变 (GLS) 测量的左心室 (LV) 功能受损,在心力衰竭中常见,其中保留了喷射分数 (HFpEF). 更糟糕的GLS预测HFpEF患者的住院和心血管死亡.
科学领域:
- 心脏病学 心脏病学
- 心血管成像 - 心血管成像
- 心脏衰竭研究研究
背景情况:
- 亚临床左心室 (LV) 损伤在心力衰竭中被识别为具有保存的喷射分数 (HFpEF).
- 使用应变成像评估LV心肌变形对于理解HFpEF病理生理学至关重要.
研究的目的:
- 评估通过应变成像评估的LV心肌变形与因心力衰竭 (HF) 或心血管死亡而重复住院之间的关联.
- 在一个大型国际HFpEF队列中调查全球纵向菌株 (GLS) 的预后价值.
主要方法:
- 利用二维斑点跟踪测量了PARAGON-HF研究中的790名HFpEF患者的GLS.
- 分析了GLS与HF住院或心血管死亡的综合结果之间的关系,并调整了临床混因素.
主要成果:
- 大约47%的患者表现出GLS受损 (绝对GLS<16%),这与N-终端B型亲尿素水平升高相关.
- 更糟糕的GLS与初级复合结果的风险增加显著相关 (HR每1%下降1.06;95%CI1.02-1.11).
- 对于复合结果,GLS没有改变sacubitril/valsartan与valsartan的治疗效果.
结论:
- 在HFpEF中,即使在具有保留射出分数的患者中,LV缩功能受损也很普遍.
- 通过GLS识别的微妙的LV缩性损伤是HFpEF中不良心血管事件的显著预测因素.
- 这些发现强调了LV心肌变形在HFpEF病理生理学的重要性.
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