Kasner Mario, Gaub Regina, Sinning David, Westermann Dirk, Steendijk Paul, Hoffmann Wolfgang, Schultheiss Heinz-Peter, Tschöpe Carsten
Department of Cardiology and Pneumology, Charité-University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
Eur J Echocardiogr. 2010 Oct;11(9):743-51. doi: 10.1093/ejechocard/jeq060. Epub 2010 May 19.
Strain rate imaging provides direct information on intrinsic myocardial function and may improve the diagnostic of diastolic dysfunction in heart failure with normal ejection fraction (HFNEF). We therefore correlated global strain with pressure-volume (PV) loop analysis and compared it with flow and tissue Doppler measurements.
Longitudinal two-dimensional strain rate and flow and tissue Doppler (TDI) indices were measured simultaneously and correlated with diastolic indices of PV relationship obtained by a conductance catheter in 21 patients with HFNEF and 12 controls. HFNEF patients showed a reduced global strain rate during isovolumetric relaxation (SR(IVR)) [0.27 (0.12-0.39) vs. 0.44 (0.29-0.56) s(-1), P = 0.028]. Global strain rate during early (SR(E)) and late (SR(L)) diastole did not defer from controls. Their ratios with early transmitral flow, E/SR(IVR) and E/SR(E), were both elevated in HFNEF [3.68 (2.57-7.52) vs. 1.73 (1.47-2.37) m, P = 0.007 and 1.13 (0.76-1.36) vs. 0.83 (0.57-1.04) m, P = 0.030]. SR(E) and SR(IVR) correlated with left ventricular (LV) relaxation τ (r = 0.40 and 0.47, P < 0.05); E/SR(IVR) and E/SR(E) with LV end-diastolic pressure (r = 0.49 and 0.57, P < 0.01) and LV stiffness constant β (r = 0.42 and 0.43, P < 0.01). Neither of the strain rate indices were significantly more accurate than TDI (area under the curve: SR(E) 0.55, SR(IVR) 0.70, E'/A' 0.72, E/SR(E) 0.75, E/SR(IVR) 0.80, and E/E' 0.83).
Strain rate imaging is accurate in detecting increased LV stiffness in HFNEF, but it is not superior to already established TDI analysis including E/E' in patients with only mild degree of disease.
应变率成像可提供关于心肌固有功能的直接信息，可能改善对射血分数正常的心力衰竭（HFNEF）患者舒张功能障碍的诊断。因此，我们将整体应变与压力-容积（PV）环分析相关联，并将其与血流和组织多普勒测量结果进行比较。
在21例HFNEF患者和12例对照者中，同时测量纵向二维应变率、血流和组织多普勒（TDI）指标，并将其与通过电导导管获得的PV关系舒张指标相关联。HFNEF患者在等容舒张期的整体应变率（SR(IVR)）降低[0.27（0.12 - 0.39）对0.44（0.29 - 0.56）s⁻¹，P = 0.028]。舒张早期（SR(E)）和晚期（SR(L)）的整体应变率与对照组无差异。它们与早期二尖瓣血流的比值，E/SR(IVR)和E/SR(E)，在HFNEF患者中均升高[3.68（2.57 - 7.52）对1.73（1.47 - 2.37）m，P = 0.007；1.13（0.76 - 1.36）对0.83（0.57 - 1.04）m，P = 0.030]。SR(E)和SR(IVR)与左心室（LV）舒张时间常数τ相关（r = 0.40和0.47，P < 0.05）；E/SR(IVR)和E/SR(E)与LV舒张末期压力相关（r = 0.49和0.57，P < 0.01）以及LV僵硬度常数β相关（r = 0.42和0.43，P < 0.01）。应变率指标均不比TDI更准确（曲线下面积：SR(E) 0.55，SR(IVR) 0.70，E'/A' 0.72，E/SR(E) 0.75，E/SR(IVR) 0.80，E/E' 0.83）。
应变率成像在检测HFNEF患者LV僵硬度增加方面是准确的，但在疾病程度仅为轻度的患者中，它并不优于已确立的TDI分析，包括E/E'。
