慢性心力衰竭并以左房肌病和左室肌病为主的患者。

IF 1.9 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Xuanyi Jin, Wan Ting Tay, Dinna Soon, David Sim, Seet Yoong Loh, Sheldon Lee, Fazlur Jaufeerally, Lieng Hsi Ling, A Mark Richards, Adriaan A Voors, Carolyn S P Lam, Joost P van Melle
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引用次数: 0

摘要

背景:左心房(LA)和心室(LV)功能损害常共存于心力衰竭(HF)患者。然而,一些心衰患者有不成比例的左室或左室功能障碍。我们的目的是通过左室射血分数(LVEF)谱对慢性HF患者队列中以左室和左室肌病为主的患者进行特征描述。方法:在全国范围内,前瞻性,多中心,观察性心衰队列中,对每位患者进行经胸超声心动图检查。采用二维散斑跟踪分析专用软件测量左室储层应变和左室总纵应变(LVGLS),评价左室和左室功能,确定肌病。结果:共纳入374例慢性HF患者(平均年龄58.9±11.5岁,女性占20%,平均LVEF 39±17%)。通过计算LA库和LVGLS之间线性回归的残差,我们确定了47例主要LA肌病患者,271例LA/LV平衡患者和56例主要LV肌病患者。以LA肌病为主的患者年龄较大,房颤(AF)、糖尿病患病率较高,血浆n -末端前b型利钠肽(NT-proBNP)、生长差异因子15(GDF15)、高敏感性肌钙蛋白T (hs-TNT)浓度较高,左、右心房扩张更严重,右心房功能较其他组差(均p值)。虽然大多数心衰患者有平衡的左室/左室肌病,但以左室肌病为主的患者以年龄较大、房颤较多、糖尿病较多、心脏应激和损伤循环生物标志物较高以及预后较差为特征。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Patients with chronic heart failure and predominant left atrial versus left ventricular myopathy.

Background: Left atrial (LA) and ventricular (LV) functional impairment often co-exist in patients with heart failure (HF). However, some patients with HF have a disproportionate LA or LV dysfunction. We aimed to characterize patients with predominant LA and LV myopathy in a cohort of patients with chronic HF across the spectrum of LV ejection fraction (LVEF).

Methods: From a nationwide, prospective, multi-center, observational HF cohort, transthoracic echocardiographic examination was performed on each patient. LA reservoir strain and LV global longitudinal strain (LVGLS) were measured using dedicated software of the two-dimensional speckle tracking analysis to evaluate LA and LV function and to define the myopathy.

Results: A total of 374 patients with chronic HF (mean age 58.9±11.5 years, 20% female, mean LVEF 39±17%) were included. By calculating the residuals from the linear regression between LA reservoir and LVGLS, we identified 47 patients with predominant LA myopathy, 271 patients with balanced LA/LV and 56 patients with predominant LV myopathy. Patients with predominant LA myopathy were older, had a higher prevalence of atrial fibrillation (AF), diabetes, higher plasma concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP), Growth differential factor 15(GDF15), high sensitivity Troponin T (hs-TNT) as well as more dilated left and right atria, and worse right atrial function compared to other groups (all p-values < 0.05). Using multivariable logistic regression adjusted for LVEF and LA size, independent predictors of predominant LA myopathy were the presence of AF, diabetes, and higher GDF15, whereas absence of diabetes independently predicted predominant LV myopathy. Patients with predominant LA myopathy group had a lower probability of survival than the other groups (Log rank p-value = 0.01).

Conclusion: While most patients with HF have balanced LA/LV myopathy, those with predominant LA myopathy are characterized by older age, more AF, more diabetes, higher circulating biomarkers of cardiac stress and injury, and worse outcomes.

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来源期刊
Cardiovascular Ultrasound
Cardiovascular Ultrasound CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
4.10
自引率
0.00%
发文量
28
审稿时长
>12 weeks
期刊介绍: Cardiovascular Ultrasound is an online journal, publishing peer-reviewed: original research; authoritative reviews; case reports on challenging and/or unusual diagnostic aspects; and expert opinions on new techniques and technologies. We are particularly interested in articles that include relevant images or video files, which provide an additional dimension to published articles and enhance understanding. As an open access journal, Cardiovascular Ultrasound ensures high visibility for authors in addition to providing an up-to-date and freely available resource for the community. The journal welcomes discussion, and provides a forum for publishing opinion and debate ranging from biology to engineering to clinical echocardiography, with both speed and versatility.
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