The role of three-dimensional speckle tracking imaging in risk stratification and prognosis in hypertrophic cardiomyopathy
10.3760/cma.j.issn.1004-4477.2018.10.001
- VernacularTitle:三维斑点追踪技术在肥厚型心肌病危险分层和预后评估中的应用
- Author:
Jie ZHAO
1
;
Jing WANG
;
Liwen LIU
;
Yu ZHENG
;
Wenxia LI
;
Fan YANG
;
Nan KANG
;
Lei ZUO
Author Information
1. 空军军医大学
- Keywords:
Three-dimensional speckle tracking imaging;
Cardiomyopathy,hypertrophic;
Risk stratification;
Prognosis
- From:
Chinese Journal of Ultrasonography
2018;27(10):829-835
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate whether three-dimensional speckle tracking imaging ( 3D-STI) combined with conventional echocardiography can identify cardiac functional characteristics and predict adverse cardiovascular events in patients with hypertrophic cardiomyopathy ( HCM ) . Methods One hundred and eighty HCM patients were involved in the study . All patients were followed up to March 2017 after comprehensive evaluation of 3D-STI and conventional echocardiography for endpoint events . The endpoint events were divided into the primary and secondary endpoints . The primary endpoints included sudden cardiac death ( SCD ) , survival after cardioversion and appropriate implantable cardioverter-defibrillator( ICD) discharge ;the secondary endpoints included acute myocardial infarction ,heart failure hospitalization ,thromboembolism and endstage HCM . The composite endpoints contained primary or secondary endpoints . Results ①Totally 175 HCM patients completed the follow-up [ ( 435 ± 204) days] . During follow-up ,25 patients ( 14 .3% ) reached composite endpoints :8 cases of the primary endpoints ( 3 cases of sudden cardiac death ,3 cases of survival after defibrillation ,and 2 cases of appropriate implantable cardioverter-defibrillator discharge ) ; 17 cases of the second endpoints ( 14 cases of heart failure hospitalization ,2 cases of thromboembolism ,and 1 case of end-stage HCM ) . ② Patients with primary endpoints had higher NYHA class ,reduced systolic and early diastolic mitral annular velocities (MV s′and MV e′) ,decreased systolic tricuspid annular velocity ( TV s′) ,and impaired 3D left ventricular global longitudinal strain ( GLS ) ,as compared to those without primary endpoints ( n ＝ 167 ) ( P ＜ 0 .05 ) . Impaired 3D GLS ( hazard ratio was 0 .72 ,95% CI was 0 .53 －0 .98 , P ＝ 0 .035) and decreased TV s′( hazard ratio was 0 .70 ,95% CI was 0 .54－0 .91 , P ＝0 .007) were independent predictor factor for primary endpoints . 3D GLS≤11 .7% or TV s′≤12 .7 cm/s raised the risk of primary endpoints . ③Similarly ,HCM patients with composite endpoints ( n ＝25) had higher NYHA class ,enlarged left atrial diameter ( LAD) , reduced MV s′,MV e′ and TV s′,as well as impaired 3D GLS ( P ＜ 0 .05) ,when compared to those without composite endpoints ( n＝150) . Moreover ,impaired 3D GLS ( hazard ratio was 0 .68 ,95% CI was 0 .56－0 .81 , P ＝0 .000) was independent predictor for composite endpoints ;and patients with 3D GLS≤12 .9% was more susceptible to composite endpoints . Conclusions 3D GLS combined with TV s′ are of value in predicting adverse cardiovascular events .
