背景:左心室(LV)和动脉系统功能的现代非侵入性指标的价值,在同期治疗的急性冠脉综合征(ACS)患者中,它们在确定预后方面的相互作用尚不明确。该研究旨在确定心室-动脉(VA)耦合的关联,左心室全球纵向收缩峰值应变(GLPSS),总体应变率(GSR)和舒张末期压30mmHg(V30)时的舒张末期容积与ACS患者的长期临床结局。
方法:对569例ACS患者进行超声心动图检查,随访时间>12个月。单变量Cox比例风险回归模型调整为各种临床因素,包括左心室射血分数降低<40%,用于比较患者左心室和动脉系统功能的各种指标的第一和第三部分之间的相互作用,以预测组合终点(定义为中风,心肌梗塞或死亡)。结果表示为具有95%置信区间(CI)的风险比(HR)。
结果:在625天的中位随访期间有57项临床结果。增加的VA偶联>1.68(HR2.4;95%CI:1.04-5.6);V30>107mL(HR4.5;95%CI:1.9-10.6),GLPSS>-12.8%(HR2.4;95%CI:1.02-5.7),GSR>-0.961/s(HR3.8;95%CI:1.6-9.1)与危险增加密切相关。
结论:同时接受治疗的ACS患者的样本,左心室功能的非侵入性指标的异常值及其与动脉系统的相互作用,预测不良临床结局,独立于左心室射血分数。
BACKGROUND: The value of modern non-invasive indices of the left ventricle (LV) and arterial system function, and their interaction for determining prognosis in contemporarily treated patients with acute coronary syndrome (ACS) is not well established. The study aimed to determine the association of ventricular-arterial (VA) coupling, LV global longitudinal peak systolic strain (GLPSS), global strain rate (GSR) and end-diastolic volume at end-diastolic pressure 30mmHg (V30) with long-term clinical outcomes in patients with ACS.
METHODS: Echocardiography was applied in 569 ACS patients followed up for >12months after hospitalization. Univariate Cox proportional hazard regression models adjusted to various clinical factors, including reduced LV ejection fraction <40%, were used to compare patients between the first and third tertiles of various indices of LV and arterial systems function and their interaction for the prediction of a combined end-point (defined as either stroke, myocardial infarction or death). Results are presented as hazard ratio (HR) with 95% confidence interval (CI).
RESULTS: There were 57 clinical outcomes during a median follow-up of 625days. Increased VA coupling >1.68 (HR 2.4; 95% CI: 1.04-5.6); V30>107mL (HR 4.5; 95% CI: 1.9-10.6), GLPSS > -12.8% (HR 2.4; 95% CI: 1.02-5.7), GSR > -0.96 1/s (HR 3.8; 95% CI: 1.6-9.1) were robustly associated with increased hazard.
CONCLUSIONS: With a sample of contemporarily treated ACS patients, abnormal values of non-invasive indices of LV function and their interaction with arterial system, predict adverse clinical outcomes, independently of LV ejection fraction.