Prognostic Value of LV Global Longitudinal Strain by 2D and 3D Speckle-Tracking Echocardiography in Patients With HFpEF.

IF 6.5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Cardiovascular Imaging Pub Date : 2025-02-01 Epub Date: 2025-01-13 DOI:10.1161/CIRCIMAGING.124.016975

Yixia Lin, Mingxing Xie, Li Zhang, Yanting Zhang, Peige Zhang, Xin Chen, Mengmeng Ji, Lang Gao, Qing He, Zhenni Wu, Yali Yang, Yuman Li

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引用次数: 0

Abstract

Background: In patients with heart failure with preserved ejection fraction (HFpEF), the impact of type 2 diabetes (T2D) on left ventricular global longitudinal strain (LV GLS) and its prognostic implications remains unclear. We aimed to evaluate LV function using two-dimensional (2D) and three-dimensional (3D) speckle-tracking echocardiography in patients with HFpEF with and without T2D, and to investigate its prognostic significance.

Methods: A total of 335 patients with HFpEF were prospectively enrolled for echocardiographic evaluation. LV GLS was obtained using 2D- and 3D-speckle-tracking echocardiography. Cox proportional hazards regression was used to determine predictors of adverse outcomes. The C-index, Akaike information criterion, integrated discrimination improvement, and net reclassification improvement were used to assess model performance and discriminative ability.

Results: LV 2D-GLS and 3D-GLS were impaired in patients with HFpEF and T2D compared with those without T2D. After a median follow-up of 17.6 months, 150 patients experienced adverse outcomes. Both 2D-GLS (hazard ratio, 1.323 [95% CI, 1.225-1.429]; P<0.001) and 3D-GLS (hazard ratio, 1.412 [95% CI, 1.316-1.515]; P<0.001) were independent predictors of adverse outcomes in patients with HFpEF after adjustment for confounders. The predictive accuracy of a model incorporating 3D-GLS (Akaike information criterion=-583.9, C-index=0.775 [95% CI, 0.742-0.808]) was superior to models using 2D-GLS (Akaike information criterion=-533.3, C-index=0.719 [95% CI, 0.678-0.760], ΔC-index=0.056; P=0.034) and LV ejection fraction (Akaike information criterion=-498.9, C-index=0.659 [95% CI, 0.610-0.708], ΔC-index=0.116; P<0.001). The addition of 2D-GLS and 3D-GLS to the base model significantly enhanced its discriminatory and predictive abilities (integrated discrimination improvement=0.225 and 0.280; net reclassification improvement=0.612 and 0.734, respectively, P<0.001 for all).

Conclusions: LV 2D-GLS and 3D-GLS are impaired in patients with HFpEF and T2D, and are independent predictors of adverse outcomes. Moreover, 3D-GLS provides incremental prognostic value over 2D-GLS.

Registration: URL: https://www.chictr.org.cn/; Unique identifier: ChiCTR2100047487.

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二维和三维斑点跟踪超声心动图对HFpEF患者左室整体纵向应变的预后价值。

背景：在保留射血分数（HFpEF）的心力衰竭患者中，2型糖尿病（T2D）对左心室整体纵向应变（LV GLS）的影响及其预后意义尚不清楚。我们的目的是通过二维（2D）和三维（3D）斑点跟踪超声心动图评估伴有和不伴有T2D的HFpEF患者的左室功能，并探讨其预后意义。方法：对335例HFpEF患者进行前瞻性超声心动图评价。采用二维和三维斑点跟踪超声心动图获得左室GLS。采用Cox比例风险回归确定不良结局的预测因子。采用c指数、赤池信息准则、综合判别改进和净重分类改进评价模型性能和判别能力。结果：HFpEF合并T2D患者与未合并T2D患者相比，左室2D-GLS和3D-GLS受损。中位随访17.6个月后，150名患者出现了不良结果。2D-GLS(风险比，1.323 [95% CI, 1.225-1.429]；PPP=0.034)和左室射血分数(Akaike信息标准=-498.9,C-index=0.659 [95% CI, 0.610-0.708]， ΔC-index=0.116；ppp结论：lv2d - gls和3D-GLS在HFpEF和T2D患者中受损，是不良结局的独立预测因子。此外，3D-GLS比2D-GLS具有更高的预后价值。注册：网址：https://www.chictr.org.cn/；唯一标识符：ChiCTR2100047487。

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来源期刊

Circulation: Cardiovascular Imaging 医学-核医学

CiteScore

6.30

自引率

2.70%

发文量

225

审稿时长

6-12 weeks

期刊介绍： Circulation: Cardiovascular Imaging, an American Heart Association journal, publishes high-quality, patient-centric articles focusing on observational studies, clinical trials, and advances in applied (translational) research. The journal features innovative, multimodality approaches to the diagnosis and risk stratification of cardiovascular disease. Modalities covered include echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging and spectroscopy, magnetic resonance angiography, cardiac positron emission tomography, noninvasive assessment of vascular and endothelial function, radionuclide imaging, molecular imaging, and others. Article types considered by Circulation: Cardiovascular Imaging include Original Research, Research Letters, Advances in Cardiovascular Imaging, Clinical Implications of Molecular Imaging Research, How to Use Imaging, Translating Novel Imaging Technologies into Clinical Applications, and Cardiovascular Images.