Imbalzano Egidio, Zito Concetta, Carerj Scipione, Oreto Giuseppe, Mandraffino Giuseppe, Cusmà-Piccione Maurizio, Di Bella Gianluca, Saitta Carlo, Saitta Antonino
Department of Internal Medicine and Medical Therapy, University of Messina, Italy.
Echocardiography. 2011 Jul;28(6):649-57. doi: 10.1111/j.1540-8175.2011.01410.x. Epub 2011 Jun 15.
Conventional transthoracic echocardiography (TTE) and tissue Doppler imaging (TDI) are usually unable to reveal very early subtle abnormalities in left ventricular (LV) systolic function caused by hypertension, prior to manifestation of hypertrophy (LVH). This study was undertaken to assess whether speckle tracking echocardiography (STE) provides more insight into early hypertension-induced LV systolic dysfunction, with the purpose of identifying patients at higher risk for heart failure (HF).
Fifty-one patients (56.5 ± 14 years) and 51 controls (52 ± 12.6 years) were enrolled. According to the presence or absence of LVH, patients were classified as LVH((+)) and LVH((-)) , respectively. Global longitudinal function was calculated by TDI, global strains [longitudinal (LS), radial (RS), and circumferential (CS)] and twist were assessed by STE.
Conventional TTE showed a LV diastolic dysfunction with normal systolic function in all patients. TDI was able to detect a systolic dysfunction only in the LVH((+)) group (P < 0.001) whereas STE revealed an impairment of systolic LS in all patients, including those without hypertrophy (P = 0.02). Furthermore, in the LVH((+)) group, STE showed reduced RS and increased CS and twist. These last alterations were observed with respect to both controls (RS: P = 0.02; CS: P = 0.05; twist: P < 0.001) and LVH((-)) patients (RS: P = 0.01; CS: P = 0.003; twist: P = 0.001).
In hypertensive patients, STE provides more detailed information than conventional echocardiography and TDI, since it reveals a systolic dysfunction before hypertrophy occurs (Stage A of ACC/AHA classification of HF) and identifies some early LV mechanic changes that might improve the clinical management of these patients.
传统经胸超声心动图（TTE）和组织多普勒成像（TDI）通常无法在左心室肥厚（LVH）出现之前，揭示高血压所致左心室（LV）收缩功能的极早期细微异常。本研究旨在评估斑点追踪超声心动图（STE）能否更深入了解早期高血压诱发的左心室收缩功能障碍，以识别心力衰竭（HF）风险较高的患者。
纳入51例患者（年龄56.5±14岁）和51例对照者（年龄52±12.6岁）。根据是否存在LVH，将患者分别分为LVH(+)组和LVH(-)组。通过TDI计算整体纵向功能，通过STE评估整体应变[纵向（LS）、径向（RS）和圆周（CS）]及扭转。
传统TTE显示所有患者左心室舒张功能障碍但收缩功能正常。TDI仅在LVH(+)组检测到收缩功能障碍（P<0.001），而STE显示所有患者包括无肥厚者的收缩期LS均受损（P = 0.02）。此外，在LVH(+)组中，STE显示RS降低，CS和扭转增加。与对照组（RS：P = 0.02；CS：P = 0.05；扭转：P<0.001）和LVH(-)患者（RS：P = 0.01；CS：P = 0.003；扭转：P = 0.001）相比，均观察到这些最后的改变。
在高血压患者中，STE比传统超声心动图和TDI提供更详细的信息，因为它能在肥厚发生之前揭示收缩功能障碍（HF的ACC/AHA分类中的A期），并识别一些早期左心室力学变化，这可能改善这些患者的临床管理。
