Nagueh Sherif F, McFalls Judy, Meyer Denise, Hill Rita, Zoghbi William A, Tam James W, Quiñones Miguel A, Roberts Robert, Marian A J
Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Tex, USA.
Circulation. 2003 Jul 29;108(4):395-8. doi: 10.1161/01.CIR.0000084500.72232.8D. Epub 2003 Jul 14.
Systolic (Sa) and diastolic (Ea) myocardial velocities measured by tissue Doppler (TD) imaging (TDI) recently were shown to be decreased in subjects who have mutations causing hypertrophic cardiomyopathy (HCM) but who do not have left ventricular (LV) hypertrophy. By studying these subjects at a later date, we sought to determine whether TDI predicts the subsequent evolution of the HCM phenotype.
Serial 2D and Doppler echocardiography were performed in 12 subjects (age range, 17 to 51 years) with HCM-causing mutations on 2 occasions: before development of hypertrophy and 2 years later. Twelve age- and gender-matched family members without mutations were included as control subjects. In those with mutations, mean septal thickness and LV mass were 1.07+/-0.14 cm and 103.0+/-11 g at baseline, respectively, and increased to 1.30+/-0.36 cm and 193.0+/-78 g at follow-up (P<0.01), with 6 subjects satisfying HCM diagnostic criteria. Sa and Ea velocities in those with mutations were lower compared with control subjects at baseline and follow-up (lateral Sa, 15+/-1.2 versus 8.2+/-2.1 cm/s; lateral Ea, 16.5+/-2.8 versus 8.1+/-2.3 cm/s; P<0.01). At 2 years, left atrial volume and pulmonary venous flow indices of LV filling pressures increased, whereas TD early and late diastolic velocities decreased (all P<0.05) in those with the mutations. Control subjects had no significant interval changes of the above parameters.
Subsequent development of HCM in subjects with initially reduced TD velocities establishes TDI as a reliable method for early identification of HCM mutation carriers.
最近通过组织多普勒（TD）成像（TDI）测量的收缩期（Sa）和舒张期（Ea）心肌速度在患有导致肥厚型心肌病（HCM）的突变但无左心室（LV）肥厚的受试者中显示降低。通过在稍后日期对这些受试者进行研究，我们试图确定TDI是否能预测HCM表型的后续演变。
对12名患有导致HCM突变的受试者（年龄范围17至51岁）进行了两次连续的二维和多普勒超声心动图检查：在肥厚发生之前和2年后。包括12名年龄和性别匹配的无突变家庭成员作为对照受试者。在有突变的受试者中，基线时平均室间隔厚度和LV质量分别为1.07±0.14 cm和103.0±11 g，随访时增加至1.30±0.36 cm和193.0±78 g（P<0.01），6名受试者符合HCM诊断标准。有突变的受试者在基线和随访时的Sa和Ea速度低于对照受试者（侧壁Sa，15±1.2对8.2±2.1 cm/s；侧壁Ea，16.5±2.8对8.1±2.3 cm/s；P<0.01）。在2年时，有突变的受试者左心房容积和LV充盈压的肺静脉血流指数增加，而TD舒张早期和晚期速度降低（均P<0.05）。对照受试者上述参数无明显的间期变化。
最初TD速度降低的受试者中HCM的后续发展确立了TDI作为早期识别HCM突变携带者的可靠方法。
