心房颤动非缺血性扩张型心肌病患者的左心房变形分析。

European heart journal. Imaging methods and practice Pub Date : 2024-06-25 eCollection Date: 2024-01-01 DOI:10.1093/ehjimp/qyae063
Eduard Ródenas-Alesina, Jordi Lozano-Torres, Pablo Eduardo Tobías-Castillo, Clara Badia-Molins, Rosa Vila-Olives, Maria Calvo-Barceló, Guillem Casas, Toni Soriano-Colomé, Aleix Olivella San Emeterio, Rubén Fernández-Galera, Ana B Méndez-Fernández, José A Barrabés, Ignacio Ferreira-González, José Rodríguez-Palomares
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引用次数: 0

摘要

目的:心房颤动(AF)是非缺血性扩张型心肌病(NIDCM)的常见合并症,会影响左心房(LA)功能的常规测量。我们的目的是确定 LA 功能分析是否能识别发生重大心血管事件 (MACE) 风险较高的患者:对2015年至2019年期间转诊至一家中心进行经胸超声心动图(TTE)检查的房颤NIDCM患者进行回顾性研究。测量了峰值心房纵向应变(PALS)以及LA排空分数和LA充盈指数(LAFI = E波/PALS)。进行了 Cox 回归分析。共纳入153名患者(中位年龄74岁,左室射血分数(LVEF)35%),其中57人(37.3%)在中位随访3.2年后发生MACE。在对年龄、糖尿病、左心室射血分数(LVEF)、左心室整体纵向应变(LV-GLS)和 LA 容积指数进行调整后,LAFI 是唯一与 MACE 相关的独立 TTE 参数[调整后的危险比 (HR) = 每增加 1.02,P = 0.024],最佳临界值为≥15。单独分析时,LAFI ≥15可预测MACE的各个组成部分:MACE HR = 1.95,95%置信区间(CI)1.16-3.30;心血管死亡HR = 3.68,95% CI 1.41-9.56;心衰入院HR = 2.13,95% CI 1.19-3.80;室性心律失常HR = 4.72,95% CI 1.52-14.67。较高的LAFI与LV-GLS、E/e'、肺动脉(PA)收缩压、三尖瓣环平面收缩期偏移以及右心室与PA耦合的恶化有关:LA 变形分析适用于出现房颤的 NIDCM 患者。LAFI 可识别 MACE 风险较高的患者,并与较高的肺动脉压力和较差的右心室功能相关,表明 LAFI 较高的患者左侧心室压力升高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Left atrial deformation analysis in patients with non-ischaemic dilated cardiomyopathy in atrial fibrillation.

Aims: Atrial fibrillation (AF) is a common comorbidity in non-ischaemic dilated cardiomyopathy (NIDCM) affecting conventional measures of left atrial (LA) function. We aimed to determine whether LA function analysis could identify patients at higher risk of major cardiovascular events (MACEs).

Methods and results: A retrospective study of patients with NIDCM in AF referred to a single centre for transthoracic echocardiography (TTE) between 2015 and 2019. Peak atrial longitudinal strain (PALS) was measured along with LA emptying fraction and LA filling index (LAFI = E wave/PALS). Cox regression analysis was conducted. A total of 153 patients were included [median age 74 years, left ventricular ejection fraction (LVEF) 35%], and 57 (37.3%) had MACE after a median follow-up of 3.2 years. LAFI was the only independent TTE parameter associated with MACE after adjustment for age, diabetes, LVEF, left ventricular global longitudinal strain (LV-GLS), and LA volume index [adjusted hazard ratio (HR) = 1.02 per point increase, P = 0.024], with the best cut-off at ≥15. LAFI ≥15 predicted each of MACE components when separately analysed: MACE HR = 1.95, 95% confidence interval (CI) 1.16-3.30; cardiovascular death HR = 3.68, 95% CI 1.41-9.56, heart failure admission HR = 2.13, 95% CI 1.19-3.80, and ventricular arrhythmia HR = 4.72, 95% CI 1.52-14.67. Higher LAFI was associated with worsening LV-GLS, E/e', systolic pulmonary artery (PA) pressure, tricuspid annular plane systolic excursion, and right ventricular to PA coupling.

Conclusion: LA deformation analysis is feasible in patients with NIDCM presenting with AF. LAFI may identify patients at higher risk of MACE and correlates with higher pulmonary pressures and worse right ventricular function, suggesting an elevation of left-sided ventricular pressures in patients with higher LAFI.

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