Cappelli Francesco, Porciani Maria C, Bergesio Franco, Perfetto Federico, De Antoniis Francesco, Cania Ardian, Tronconi Francesca, Ricceri Ilaria, Padeletti Luigi
Heart and Vessels Department, University of Florence, Florence, Italy.
Clin Physiol Funct Imaging. 2011 Mar;31(2):159-65. doi: 10.1111/j.1475-097X.2010.00987.x. Epub 2010 Nov 5.
Recently, two-dimensional (2D) speckle-tracking echocardiography has enabled assessment of a particular behaviour of left ventricular (LV) motion defined as twisting/untwisting. The aim of our study is to evaluate whether in early stage of hypertension and systemic amyloidosis, subclinical alteration of LV twist and untwist is already present even if no LV hypertrophy is evidenced.
Forty-seven patients with light chain immunoglobulin amyloidosis (AL) entered the study and were classified having cardiac amyloidosis (CA) or not (NCA) if the mean value of LV wall thickness was ≥12 mm or not. Twenty-two consecutive patients with history of arterial essential hypertension (Hyp Group) and no sign of LV hypertrophy were enrolled. A total of 26 asymptomatic healthy subjects, age-matched, were analysed as control group. All three groups of patients and healthy subjects underwent traditional and 2D speckle-tracking echocardiography evaluation. LV diameters, volumes, wall thickness, mass, ejection fraction, E/A and E/E' ratio were evaluated.
Twisting and untwisting rates were significantly increased in NCA and Hyp group when compared with CA and control group. Moreover, despite similar LV mass and diastolic dysfunction degree, untwisting rate peak was significantly delayed in NCA when compared with Hyp group. In patients with CA, untwisting rate delay was similar to patients with NCA.
Our results show that amyloidosis and systemic hypertension produce both LV twist and untwist rate enhancement before LV hypertrophy is developed. In patients with amyloidosis irrespectively of LV infiltration degree, a significant LV untwisting rate peak delay occurs suggesting that different aetiology of cardiac involvement could differently affect LV untwisting rate.
最近，二维（2D）斑点追踪超声心动图能够评估左心室（LV）运动的一种特定行为，即扭转/解扭。我们研究的目的是评估在高血压和系统性淀粉样变性的早期阶段，即使没有左心室肥厚的证据，左心室扭转和解扭是否已经存在亚临床改变。
47例轻链免疫球蛋白淀粉样变性（AL）患者进入研究，如果左心室壁厚度的平均值≥12mm，则分为有心脏淀粉样变性（CA）或无心脏淀粉样变性（NCA）。连续纳入22例有原发性高血压病史（高血压组）且无左心室肥厚迹象的患者。共分析26名年龄匹配的无症状健康受试者作为对照组。所有三组患者和健康受试者均接受传统和二维斑点追踪超声心动图评估。评估左心室直径、容积、壁厚度、质量、射血分数、E/A和E/E'比值。
与CA组和对照组相比，NCA组和高血压组的扭转和解扭率显著增加。此外，尽管左心室质量和舒张功能障碍程度相似，但与高血压组相比，NCA组的解扭率峰值明显延迟。在CA患者中，解扭率延迟与NCA患者相似。
我们的结果表明，淀粉样变性和系统性高血压在左心室肥厚发生之前都会导致左心室扭转和解扭率增加。在淀粉样变性患者中，无论左心室浸润程度如何，都会出现明显的左心室解扭率峰值延迟，这表明心脏受累的不同病因可能对左心室解扭率产生不同影响。
