Pavlopoulos Harry, Grapsa Julia, Stefanadi Ellie, Philippou Elena, Dawson David, Nihoyannopoulos Petros
Echocardiography Department, Imperial College of Medicine and Technology, National Heart and Lung Institute (NHLI), Hammersmith Hospital, Du Cane Road, W12 0HS London, UK.
Eur J Echocardiogr. 2008 Nov;9(6):741-7. doi: 10.1093/ejechocard/jen133. Epub 2008 Apr 4.
To investigate changes in longitudinal systolic function estimated by strain echocardiography in relation to global diastolic dysfunction and alterations in segmental relaxation patterns.
We studied 75 hypertensive patients, of whom 45 had diastolic dysfunction and normal EF, and 30 matched controls. All subjects had 2D and colour Doppler myocardial imaging. Mean longitudinal strain (S) and strain rate (SR) were averaged from the basal and mid-LV segments assessed in the longitudinal axis. Early to late diastolic SR ratio <1.1 was defined as altered segmental relaxation [segmental diastolic dysfunction (DD)]. The total number of segmental DD out of the 18 basal-mid-apical segments was calculated for all the participants. Longitudinal systolic function estimated by mean strain and SR was decreased in the hypertensive group, but was further deteriorated in the diastolic dysfunction group compared with controls. Altered Segmental Relaxation was highly correlated with longitudinal systolic dysfunction expressed by strain (r: -0.56)or SR (r: -0.57). A septal mitral annular Ea cut-off of 5.9 cm/s predicted longitudinal systolic dysfunction with a sensitivity of 81% and a specificity of 70%. A multiple linear regression model proved LVMI, systolic blood pressure (SBP) and age as independent predictors of diastolic and longitudinal systolic dysfunction and BMI to independently related to diastolic dysfunction.
Longitudinal systolic dysfunction may be present in hypertensive patients with diastolic dysfunction, especially when septal Ea < 5.9 cm/s. Altered segmental relaxation pattern is highly correlated with longitudinal systolic dysfunction. LV hypertrophy, SBP and aging are important determinants of both diastolic and longitudinal systolic dysfunction, whereas obesity appears to contribute to the appearance of diastolic dysfunction.
研究应变超声心动图评估的纵向收缩功能变化与整体舒张功能障碍及节段性舒张模式改变之间的关系。
我们研究了75例高血压患者，其中45例有舒张功能障碍且射血分数正常，以及30例匹配的对照组。所有受试者均进行了二维和彩色多普勒心肌成像。在纵轴上评估的基底段和左心室中段节段的平均纵向应变（S）和应变率（SR）进行平均。舒张早期至晚期SR比值<1.1被定义为节段性舒张异常[节段性舒张功能障碍（DD）]。计算所有参与者18个基底-中段-心尖段中节段性DD的总数。高血压组中通过平均应变和SR评估的纵向收缩功能降低，但与对照组相比，舒张功能障碍组进一步恶化更为严重。节段性舒张异常与应变（r：-0.56）或SR（r：-0.57）表示的纵向收缩功能障碍高度相关。室间隔二尖瓣环Ea截止值为5.9 cm/s时，预测纵向收缩功能障碍的敏感性为81%，特异性为70%。多元线性回归模型证明左心室质量指数、收缩压（SBP）和年龄是舒张和纵向收缩功能障碍的独立预测因素，而体重指数与舒张功能障碍独立相关。
舒张功能障碍的高血压患者可能存在纵向收缩功能障碍，尤其是当室间隔Ea<5.9 cm/s时。节段性舒张模式改变与纵向收缩功能障碍高度相关。左心室肥厚、SBP和衰老都是舒张和纵向收缩功能障碍的重要决定因素，而肥胖似乎促成了舒张功能障碍的出现。
