Clustering regional patterns of left ventricular longitudinal strain in systemic sclerosis-related pulmonary hypertension.

Autor: Lui JK; The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA. Electronic address: justin.lui@bmc.org., Cozzolino M; Section of Cardiovascular Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., Winburn M; Section of Cardiovascular Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., Trojanowski MA; Section of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., Soylemez Wiener R; The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA, USA., LaValley MP; Section of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA., Bujor AM; Section of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., Gopal DM; Section of Cardiovascular Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., Klings ES; The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2024 Dec 09; Vol. 421, pp. 132891. Date of Electronic Publication: 2024 Dec 09.
DOI: 10.1016/j.ijcard.2024.132891
Abstrakt: Background: Systemic sclerosis-related pulmonary hypertension (SSc-PH) is a heterogeneous disease, often complicated by concomitant left ventricular (LV) dysfunction. However, the contribution of heterogeneity in LV dysfunction is unclear. The objective in this study was to identify regional clusters of LV longitudinal strain via echocardiography to determine how subgroups of LV dysfunction contribute to mortality in SSc-PH.
Methods: We performed a retrospective observational study on 124 patients with SSc-PH in which LV longitudinal strain was collected over a 16-segment model. We applied K-means clustering to LV longitudinal strain at each segment using the Calinski-Harabasz index. Our primary outcome was time to all-cause mortality.
Results: Patients with SSc-PH were divided into two clusters (Cluster 1: N = 59; Cluster 2: N = 65). The most pronounced differences in longitudinal strain between each cluster were observed at the basal and mid segments, particularly at the interventricular septum. In comparison to Cluster 1, Cluster 2 was characterized by both regional and global reductions in LV and right ventricular (RV) free wall longitudinal strain, greater PH severity, and greater functional limitation by New York Heart Association with a hazard ratio of 2.06 (95 % CI: 1.21, 3.50) for all-cause mortality.
Conclusion: Using K-means clustering of regional patterns of LV longitudinal strain, we identified a distinct phenotype of patients at increased risk for mortality. Most of the pronounced differences in longitudinal strain between each cluster were observed at the basal and mid segments, particularly at the interventricular septum.
Competing Interests: Declaration of competing interest J. K. L. received research support from United Therapeutics. E. S. K. received research support from Novartis, FORMA Therapeutics/Novo Nordisk, and United Therapeutics. She received royalties for 3 topic cards in UpToDate. She is a consultant/advisory board member for Pfizer, Novo Nordisk, Vertex, and CSL Behring for sickle cell disease related clinical trials (no conflict with the present work). This study's contents are solely the responsibility of the authors and do not necessarily reflect the official views of the NIH or any of the funding organizations. The views presented here do not necessarily reflect the views of the Department of Veterans Affairs or the US government.
(Copyright © 2024 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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