估计脉搏波速度与整体纵向应变比:区分心力衰竭亚型的工具?

IF 1.9 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Cardiology Pub Date : 2025-05-23 DOI:10.1159/000546345
Ying Wang, Min Lu
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引用次数: 0

摘要

背景:心室-动脉耦合(VAC)是指心室和动脉之间的和谐相互作用,是维持最佳心血管功能所必需的。脉搏波速度(PWV)与左心室整体纵向应变(GLS)之比已被确定为评估VAC的可靠无创指标。目的:本研究旨在利用估计的脉冲波速度(ePWV)与GLS比(由散斑跟踪成像定义)来评估心力衰竭(HF)患者的无创VAC。方法:根据美国心脏协会确定的HF分期,131例患者分为4组:1组(n = 36)有发展为HF和前期HF的危险(美国心脏病学会/美国心脏协会分级A和B), 2组(n = 35)有保留射血分数(HFpEF), 3组(n = 35)有降低射血分数(HFrEF), 4组(n = 30)作为对照。为了确定ePWV/GLS比率,ePWV根据先前建立的公式计算,使用年龄和平均压力,GLS由斑点跟踪超声心动图得出。该研究评估了所有组的VAC,并与动脉弹性(Ea)和心室收缩末期弹性(Ees)比率等既定指标进行了比较。同时评估ePWV/GLS比值与超声心动图其他参数的相关性。结果:各组ePWV/GLS比值差异有统计学意义,且VAC损害程度与HF分期相关。ePWV/GLS比值以对照组和A-B期组最低(0.530±0.100 vs 0.640±0.10),其次为HFpEF组(0.992±0.215),HFrEF组最高(1.500±0.369)。ePWV/GLS比值与Ea/Ees比值呈中等相关性[r =0.753, (95% CI, 0.665-0.821)], P结论:ePWV/GLS比值是评价VAC较为方便的参数。它与HF分期密切相关,可有效区分HF亚型。尽管HFpEF患者的比例高于健康个体,但低于HFrEF患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Estimated Pulse Wave Velocity to Global Longitudinal Strain Ratio: A Tool for Differentiating Heart Failure Subtypes?

Background: Ventricular-arterial coupling (VAC), which refers to harmonious interaction between the ventricles and arteries, is essential for maintenance of optimal cardiovascular function. The ratio of the pulse wave velocity (PWV) to left ventricular global longitudinal strain (GLS) has been established as a reliable noninvasive metric for assessing VAC.

Aims: This study aimed to assess VAC noninvasively in heart failure (HF) using the estimated pulse wave velocity (ePWV) to GLS ratio, defined from speckle tracking imaging.

Methods: According to the HF stages by the American Heart Association, 131 subjects were divided into four groups: group 1 (n = 36) at risk of developing HF and pre-HF (American College of Cardiology/American Heart Association stages A and B), group 2 (n = 35) having HF with preserved ejection fraction (HFpEF), group 3 (n = 35) having HF with reduced ejection fraction (HFrEF), and group 4 (n = 30) as controls. To determine the ePWV/GLS ratio, the ePWV was calculated based on the previously established formula using age and mean pressure, and the GLS was derived from speckle tracking echocardiography. The study evaluated the VAC in all groups and compared with the established metrics such as arterial elasticity (Ea) and ventricular end-systolic elasticity (Ees) ratios. The correlation between the ePWV/GLS ratio and other parameters obtained by echocardiography was also assessed.

Results: Significant differences in the ePWV/GLS ratio were observed among the groups, and the severity of VAC impairment correlated with the HF stage. The lowest ePWV/GLS ratio was observed in the control and stage A-B group (0.530 ± 0.100 vs 0.640 ± 0.10), followed by the HFpEF group (0.992 ± 0.215), whereas the HFrEF group had the highest ratio (1.500 ± 0.369). The ePWV/GLS ratio showed a moderate correlation with the Ea/Ees ratio [r =0.753, (95% CI, 0.665-0.821), P <0.0001], but performed better in distinguishing HF subtypes. A threshold of 0.625 for the ePWV/GLS ratio was established by the ROC curve to detect the impaired VAC, with an AUROC of 0.923 and 95% CI of 0.876-0.969. In addition, the ePWV/GLS ratio was strongly associated with N-terminal pro-B-type natriuretic peptide (NT-proBNP) and moderately correlated with left ventricular mass index (LVMI), end-diastolic volume (EDV), left ventricular ejection fraction (LVEF), age, and E/e'.

Conclusion: The ePWV/GLS ratio is an easily accessible parameter for evaluating VAC. It is closely related to the HF stage and can effectively differentiate between HF subtypes. Although the ratio was higher in patients with HFpEF than in healthy individuals, it was lower than in patients with HFrEF.

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来源期刊
Cardiology
Cardiology 医学-心血管系统
CiteScore
3.40
自引率
5.30%
发文量
56
审稿时长
1.5 months
期刊介绍: ''Cardiology'' features first reports on original clinical, preclinical and fundamental research as well as ''Novel Insights from Clinical Experience'' and topical comprehensive reviews in selected areas of cardiovascular disease. ''Editorial Comments'' provide a critical but positive evaluation of a recent article. Papers not only describe but offer critical appraisals of new developments in non-invasive and invasive diagnostic methods and in pharmacologic, nutritional and mechanical/surgical therapies. Readers are thus kept informed of current strategies in the prevention, recognition and treatment of heart disease. Special sections in a variety of subspecialty areas reinforce the journal''s value as a complete record of recent progress for all cardiologists, internists, cardiac surgeons, clinical physiologists, pharmacologists and professionals in other areas of medicine interested in current activity in cardiovascular diseases.
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