Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Heart. 2010 Nov;96(21):1737-43. doi: 10.1136/hrt.2010.197533.
Subendocardial and subepicardial layers have opposite orientation of the myofibres and they are differently affected by coronary artery disease. This study investigated the differences in subendocardial and subepicardial left ventricular (LV) twist in patients with coronary artery disease.
214 patients were included in the study: 60 with first ST elevation myocardial infarction (STEMI), 111 with chronic ischaemic heart failure (HF) and 43 normal subjects. Real-time three-dimensional echocardiography provided LV volumes and function. Two-dimensional speckle tracking echocardiography differentiating the subendocardial and subepicardial layers was used for the assessment of LV twist. Patients with STEMI were divided into two groups (small and large STEMI).
Compared with normal subjects, peak subendocardial LV twist was significantly impaired in patients with STEMI (11.2 ± 6.0° vs 15.3 ± 2.7°, p<0.001). In patients with chronic HF, peak subendocardial LV twist was even more impaired (4.6 ± 3.4°, p<0.001 vs normal subjects and patients with STEMI). Conversely, peak subepicardial LV twist was not statistically different between normal subjects and patients with STEMI (8.9 ± 1.9° vs 8.4 ± 4.4°, p=0.98), whereas it was significantly impaired in patients with chronic HF (2.6 ± 2.5°, p<0.001 vs normal subjects and patients with STEMI). Peak subendocardial LV twist was not statistically different between large and small STEMI, whereas peak subepicardial LV twist was significantly lower in large STEMI than in small STEMI (7.1 ± 4.8° vs 9.6 ± 3.6°, p=0.025).
Subendocardial LV twist is reduced in patients with STEMI and chronic ischaemic HF whereas subepicardial LV twist is reduced only in chronic ischaemic HF. When STEMI are divided into large and small infarctions, it becomes evident that subepicardial LV twist is only reduced in large infarctions.
心内膜下和心外膜下心肌纤维的方向相反，它们受冠状动脉疾病的影响也不同。本研究旨在探讨冠心病患者心内膜下和心外膜下心室（LV）扭转的差异。
共纳入 214 例患者：60 例首发 ST 段抬高型心肌梗死（STEMI）患者、111 例慢性缺血性心力衰竭（HF）患者和 43 例正常对照者。实时三维超声心动图提供 LV 容量和功能。二维斑点追踪超声心动图区分心内膜下和心外膜下心肌层，用于评估 LV 扭转。STEMI 患者分为两组（小和大 STEMI）。
与正常对照组相比，STEMI 患者的峰值心内膜下 LV 扭转明显受损（11.2±6.0°比 15.3±2.7°，p<0.001）。在慢性 HF 患者中，峰值心内膜下 LV 扭转甚至更严重受损（4.6±3.4°，p<0.001 与正常对照组和 STEMI 患者）。相反，正常对照组和 STEMI 患者之间的峰值心外膜下 LV 扭转无统计学差异（8.9±1.9°比 8.4±4.4°，p=0.98），而在慢性 HF 患者中明显受损（2.6±2.5°，p<0.001 与正常对照组和 STEMI 患者）。大 STEMI 和小 STEMI 之间的峰值心内膜下 LV 扭转无统计学差异，而大 STEMI 的峰值心外膜下 LV 扭转明显低于小 STEMI（7.1±4.8°比 9.6±3.6°，p=0.025）。
STEMI 和慢性缺血性 HF 患者的心内膜下 LV 扭转减少，而只有慢性缺血性 HF 患者的心外膜下 LV 扭转减少。当 STEMI 分为大梗死和小梗死时，心外膜下 LV 扭转仅在大梗死中减少变得明显。
