Blondheim David S, Kazatsker Mark, Friedman Zvi, Lysyansky Peter, Meisel Simcha R, Asif Aya, Smirin Nahum, Shotan Avraham
Unit of Noninvasive Cardiology, Department of Cardiology, Hillel-Yaffe Medical Center, Hadera, Rappaport Faculty of Medicine, Technion, Israel.
Am J Cardiol. 2007 Jun 15;99(12):1741-4. doi: 10.1016/j.amjcard.2007.01.054. Epub 2007 Apr 26.
The adjustment of medications and dosages to the needs of individual patients with heart failure is mostly intuitive, but even when their effect on global myocardial function is measured by classic indexes, their effect on segmental function is overlooked. This study was conducted to assess the feasibility of using echocardiographic myocardial strain imaging to evaluate the effect of medication on global and segmental function in 21 ambulatory patients with heart failure (mean age 65+/-11 years) who had echocardiographic studies performed before and 2 hours after ingesting their regular morning medications. The ejection fraction, global and regional strain, and time to regional peak strain were compared between the 2 examinations. Medication induced no significant changes in mean ejection fraction (28.6+/-7.8% to 27.5+/-9.9%) and mean global strain (-9.5+/-3.6% to -9.8+/-3.2%). Changes in segmental strain depended on baseline function: normal segments (peak strain more negative than -12%) deteriorated (-15.5+/-2.7% to -13.7+/-4.6%, p<0.0001), but dysfunctional segments (peak strain less negative than -8%) improved (-5.3+/-2.0% to -7.4+/-4.3%, p<0.0001). Medication also improved segmental synchronization: average time to peak strain of segments in which peak strain was attained before aortic valve closure increased (325+/-69 to 375+/-100 ms, p<0.0001), but that of segments with postsystolic shortening at baseline decreased (451+/-93 to 435+/-93 ms, p<0.006). Thus, the time interval between time to peak strain of segments with systolic and post-systolic shortening at baseline was halved after medication. In conclusion, medications for heart failure induced an increase in the echocardiographically determined peak strain of myocardial segments with impaired function at baseline but decreased the peak strain of normally contracting segments. Medications also improved the synchronization of myocardial contraction. Neither the global ejection fraction nor global strain reflected these changes. Thus, medication tended to improve the homogeneity of left ventricular contraction.
根据心力衰竭个体患者的需求调整药物和剂量大多是凭直觉进行的，但即便通过经典指标来衡量药物对整体心肌功能的影响，其对节段性功能的影响也常被忽视。本研究旨在评估使用超声心动图心肌应变成像技术来评价药物对21例门诊心力衰竭患者（平均年龄65±11岁）整体和节段性功能影响的可行性，这些患者在服用常规晨药前及服药后2小时接受了超声心动图检查。比较两次检查的射血分数、整体及局部应变以及局部峰值应变出现时间。药物对平均射血分数（从28.6±7.8%至27.5±9.9%）和平均整体应变（从-9.5±3.6%至-9.8±3.2%）无显著影响。节段应变的变化取决于基线功能：正常节段（峰值应变比-12%更负）功能恶化（从-15.5±2.7%至-13.7±4.6%，p<0.0001），但功能障碍节段（峰值应变比-8%更不负）功能改善（从-5.3±2.0%至-7.4±4.3%，p<0.0001）。药物还改善了节段同步性：主动脉瓣关闭前达到峰值应变的节段，其平均峰值应变出现时间增加（从325±69至375±100毫秒，p<0.0001），但基线存在收缩后缩短的节段，其平均峰值应变出现时间减少（从451±93至435±93毫秒，p<0.006）。因此，服药后，基线时收缩期和收缩后缩短节段的峰值应变出现时间间隔减半。总之，心力衰竭药物使超声心动图测定的基线功能受损心肌节段的峰值应变增加，但使正常收缩节段的峰值应变降低。药物还改善了心肌收缩的同步性。整体射血分数和整体应变均未反映出这些变化。因此，药物倾向于改善左心室收缩的均匀性。
