Macron Laurent, Lairez Olivier, Nahum Julien, Berry Mathieu, Deal Leslie, Deux Jean-François, Bensaid Alexandre, Dubois Randé Jean-Luc, Gueret Pascal, Lim Pascal
Cardiovascular Department, APHP, Henri Mondor University Hospital, Creteil, France.
Eur J Echocardiogr. 2011 May;12(5):394-9. doi: 10.1093/ejechocard/jer029. Epub 2011 Apr 5.
To evaluate the impact of acoustic window on the feasibility and accuracy of longitudinal global strain (global-ε) by speckle tracking for assessing left ventricular (LV) systolic function.
The study included 70 patients (57 ± 17 years, 64% men), 28 selected patients with a suboptimal image quality (IQ) defined by three or more segments (4 ± 3 segments/patient) with wall motion score not analysable visually and 42 patients with an optimal two-dimensional (2D) echocardiography IQ. Left ventricular ejection fraction (LVEF) by Simpson's biplane method (2D-EF), global-ε by speckle tracking, and peak systolic mitral annulus velocity [systolic tissue Doppler imaging (S-TDI)] were compared with LVEF by cardiac magnetic resonance (EF-CMR; 45 ± 18%, range 9-76%). Speckle-tracking analysis was feasible in all segments with an optimal acoustic window and in 85% (103/121) of segments poorly visualized. Global-ε similarly correlated with LVEF by CMR in patients with and without optimal IQ (r = 0.81 vs. 0.82 for good vs. poor IQ). In contrast, 2D-EF (r = 0.76) and S-TDI (r = 0.64) less correlated with LVEF by CMR in patients with a suboptimal IQ. Importantly, IQ only impacted on 2D-EF inter-observer reproducibility (9 ± 5 vs. 24 ± 22% for good vs. poor IQ) but not on global-ε reproducibility (9 ± 1 vs. 8 ± 7% for good vs. poor IQ).
In patients with a limited acoustic window, longitudinal strain by speckle tracking remains accurate and reproducible for assessing global and regional LV systolic function.
评估声学窗口对通过斑点追踪测量纵向整体应变（整体应变ε）来评估左心室（LV）收缩功能的可行性和准确性的影响。
本研究纳入70例患者（年龄57±17岁，男性占64%），其中28例为图像质量欠佳（IQ）的入选患者，其定义为有三个或更多节段（每位患者4±3个节段）的室壁运动评分无法通过视觉分析，另外42例患者二维（2D）超声心动图IQ最佳。将通过辛普森双平面法测得的左心室射血分数（LVEF，2D-EF）、通过斑点追踪测得的整体应变ε以及收缩期二尖瓣环峰值速度[收缩期组织多普勒成像（S-TDI）]与通过心脏磁共振测得的LVEF（EF-CMR；45±18%，范围9-76%）进行比较。在声学窗口最佳的所有节段以及85%（103/121）可视化不佳的节段中，斑点追踪分析均可行。在IQ最佳和欠佳的患者中，整体应变ε与通过CMR测得的LVEF的相关性相似（IQ佳者r = 0.81，IQ差者r = 0.82）。相比之下，在IQ欠佳的患者中，2D-EF（r = 0.76）和S-TDI（r = 0.64）与通过CMR测得的LVEF的相关性较低。重要的是，IQ仅影响2D-EF的观察者间可重复性（IQ佳者为9±5%，IQ差者为24±22%），而不影响整体应变ε的可重复性（IQ佳者为9±1%，IQ差者为8±7%）。
在声学窗口受限的患者中，通过斑点追踪测量纵向应变在评估左心室整体和局部收缩功能方面仍然准确且可重复。
