Prognostic Value of Left Ventricular Global Longitudinal Strain in Patients With Secondary Mitral Regurgitation.
- 作者列表："Namazi F","van der Bijl P","Hirasawa K","Kamperidis V","van Wijngaarden SE","Mertens B","Leon MB","Hahn RT","Stone GW","Narula J","Ajmone Marsan N","Delgado V","Bax JJ
BACKGROUND:Left ventricular (LV) systolic function may be overestimated in patients with secondary mitral regurgitation (MR) when using LV ejection fraction (EF). LV global longitudinal strain (GLS) is a less load-dependent measure of LV function. However, the prognostic value of LV GLS in secondary MR has not been evaluated. OBJECTIVES:This study sought to demonstrate the prognostic value of LV GLS over LVEF in patients with secondary MR. METHODS:A total of 650 patients (mean 66 ± 11 years of age, 68% men) with significant secondary MR were included. The study population was subdivided based on the LV GLS value at which the hazard ratio (HR) for all-cause mortality was >1 using a spline curve analysis (LV GLS <7.0%, impaired LV systolic function vs. LV GLS ≥7.0%, preserved LV systolic function). The primary endpoint was all-cause mortality. RESULTS:During a median follow-up of 56 (interquartile range: 28 to 106 months) months, 334 (51%) patients died. Patients with a more impaired LV GLS showed significantly higher mortality rates at 1-, 2-, and 5-year follow-up (13%, 23%, and 44%, respectively) when compared with patients with more preserved LV systolic function (5%, 14%, and 31%, respectively). On multivariable analysis, LV GLS <7.0% was associated with increased mortality (HR: 1.337; 95% confidence interval: 1.038 to 1.722; p = 0.024), whereas LVEF ≤30% was not (HR: 1.055; 95% confidence interval: 0.794 to 1.403; p = 0.711). CONCLUSIONS:In patients with secondary MR, impaired LV GLS was independently associated with an increased risk for all-cause mortality, whereas LVEF was not. LV GLS may therefore be useful in the risk stratification of patients with secondary MR.
背景: 在使用左室射血分数 (EF) 的继发性二尖瓣反流 (MR) 患者中，左心室 (LV) 收缩功能可能被高估。LV全局纵向应变 (GLS) 是LV函数的较小负载依赖性度量。然而，尚未评估LV GLS在继发性MR中的预后价值。 目的: 本研究试图证明LV GLS与LVEF在继发性MR患者中的预后价值。 方法: 共纳入650例 (平均66 ± 11岁，68% 例男性) 有明显继发性MR的患者。使用样条曲线分析 (LV GLS <7.0%，LV收缩功能受损vs. LV GLS ≥ 7.0%，LV收缩功能保留)，根据LV GLS值对研究人群进行细分，在该值时，全因死亡率的风险比 (HR)> 1。主要终点是全因死亡率。 结果: 在中位随访56个月 (四分位距: 28 ~ 106个月) 期间，334例 (51%) 患者死亡。与LV收缩功能较保留的患者 (分别为13%，23% 和44%) 相比，LV GLS受损较多的患者在1、2和5年随访时显示出显著较高的死亡率 (分别为5%，14% 和31%)。在多变量分析中，LV GLS <7.0% 与死亡率增加相关 (HR: 1.337; 95% 置信区间: 1.038 ~ 1.722; p = 0.024)，而LVEF ≤ 30% 不相关 (HR: 1.055; 95% 置信区间: 0.794 ~ 1.403; p = 0.711)。 结论: 在继发性MR患者中，LV GLS受损与全因死亡风险增加独立相关，而LVEF不相关。因此，LV GLS可用于继发性MR患者的风险分层。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.