https://scholars.lib.ntu.edu.tw/handle/123456789/641620
標題: | Discriminative Ability of Left Ventricular Strain in Mildly Reduced Ejection Fraction Heart Failure | 作者: | Chung, Fa Po Chao, Tze Fan Lee, An Sheng Sung, Kuo Tzu Huang, Wen Hung Hsiao, Chih Chung Su, Cheng Huang LI-TAN YANG Chen, Ying Ju Chen, Yun Yu Liao, Jo Nan Jia-Yin Hou, Charles Yeh, Hung I. Hung, Chung Lieh |
關鍵字: | angiotensin receptor neprilysin inhibitor (ARNi) | heart failure with mildly reduced ejection fraction | LV ejection fraction | LV strain | MAGGIC score | renin-angiotensin system inhibitors (RASi) | 公開日期: | 1-十一月-2023 | 卷: | 2 | 期: | 9 | 起(迄)頁: | 100654 | 來源出版物: | JACC: Advances | 摘要: | Background: Left ventricular (LV) systolic strain is presumably a more sensitive myocardial indicator than LV ejection fraction (LVEF). Data regarding the use of LV strain in clinical risk stratification and in identifying angiotensin receptor-neprilysin inhibitor (ARNi) responders remain scarce in heart failure with mildly reduced ejection fraction (HFmrEF). Objectives: The authors aimed to examine whether assessing LV strain may provide prognostic insight beyond LVEF and help discriminate the therapeutic efficacy of ARNi in HFmrEF patients. Methods: LVEF and LV strain were quantified among 1,075 first-time hospitalized HFmrEF patients (mean age: 68.1 ± 15.1 years, 40% female). The MAGGIC (Meta-analysis Global Group in Chronic Heart Failure) risk score and its components were calculated. A Cox proportional hazard model was constructed for time-to-event analysis. Restrictive cubic spline curves were used to model the therapeutic effects of ARNi against renin-angiotensin system inhibitor according to baseline LVEF or LV strain. Results: LV strain showed a statistically significant inverse association with MAGGIC cardiac risk (coefficient: −0.14, P < 0.001). LV strain was independently associated with clinical outcomes after accounting for LVEF. MAGGIC-LV strain strata outperformed MAGGIC-LVEF strata in overall survival (Harrell's C-index: 0.71 and 0.56, P for difference <0.001; category-free net reclassification index: 0.44, P < 0.001). Lower LV strain but not LVEF consistently showed the beneficial therapeutic effects of ARNi against renin-angiotensin system inhibitor by Cox models and restrictive cubic spline (all Pinteraction <0.05). Conclusions: Among HFmrEF patients, LV strain may serve as an attractive systolic marker and provide a better prognostic and therapeutic discriminative measure for ARNi treatment than conventional LVEF. |
URI: | https://www.scopus.com/record/display.uri?eid=2-s2.0-85180249075&doi=10.1016%2fj.jacadv.2023.100654&origin=inward&txGid=fde5f731220f3eb7cb6e9ba84a66572b https://scholars.lib.ntu.edu.tw/handle/123456789/641620 |
ISSN: | 2772963X | DOI: | 10.1016/j.jacadv.2023.100654 |
顯示於: | 醫學系 |
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