University of Illinois at Chicago, Chicago, Illinois, USA.
Am J Cardiol. 2011 Nov 1;108(9):1322-6. doi: 10.1016/j.amjcard.2011.06.053. Epub 2011 Aug 18.
Distinguishing the pathologic hypertrophy of hypertrophic cardiomyopathy (HC) from the physiologic hypertrophy of professional football players (PFP) can be challenging when septal wall thickness falls within a "gray zone" between 12 and 16 mm. It was hypothesized that 2-dimensional and speckle-tracking strain (ε) echocardiography could differentiate the hearts of PFPs from those of patients with HC with similar wall thicknesses. Sixty-six subjects, including 28 professional American football players and 21 patients with HC, with septal wall thicknesses of 12 to 16 mm, along with 17 normal controls, were studied using 2-dimensional echocardiography. Echocardiographic parameters, including modified relative wall thickness (RWT; septal wall thickness + posterior wall thickness/left ventricular end-diastolic diameter) and early diastolic annular tissue velocity (e'), were measured. Two-dimensional ε was analyzed by speckle tracking to measure endocardial and epicardial longitudinal ε and circumferential ε and radial cardiac ε. Septal wall thickness was higher in patients with HC than in PFPs (14.7 ± 1.1 vs 12.9 ± 0.9 mm, respectively, p <0.001), while posterior wall thickness showed no difference. RWT was larger in patients with HC than in PFPs (0.68 ± 0.10 vs 0.48 ± 0.06, p <0.001). Longitudinal endocardial ε and radial cardiac ε were significantly higher in PFPs than in patients with HC, while circumferential endocardial ε was no different. RWT was the parameter that most accurately differentiated PFPs from patients with HC. An RWT cut point of 0.6 differentiated PFPs from patients with HC, with an area under the curve of 0.97. In conclusion, a 2-dimensional echocardiographic measure of RWT (septal wall + posterior wall thickness/left ventricular end-diastolic dimension) accurately differentiated PFPs' hearts from those of patients with HC when septal wall thickness was in the gray zone of 12 to 16 mm. Two-dimensional strain analysis identifies variations in myocardial deformation between PFPs and patients with HC with gray-zone hypertrophy.
当室间隔厚度在 12 至 16 毫米的“灰色地带”之间时，区分肥厚型心肌病 (HC) 的病理性肥大与职业足球运动员 (PFP) 的生理性肥大可能具有挑战性。假设二维和斑点追踪应变 (ε) 超声心动图可以区分壁厚度相似的 PFP 心脏和 HC 患者的心脏。使用二维超声心动图研究了 66 名受试者，包括 28 名职业美式足球运动员和 21 名 HC 患者，室间隔厚度为 12 至 16 毫米，以及 17 名正常对照者。测量了超声心动图参数，包括改良相对壁厚度 (RWT；室间隔厚度+后壁厚度/左心室舒张末期直径) 和舒张早期环状组织速度 (e')。通过斑点追踪分析二维 ε，以测量心内膜和心外膜的纵向 ε 和圆周 ε 以及径向心脏 ε。与 PFP 相比，HC 患者的室间隔厚度更高 (14.7 ± 1.1 与 12.9 ± 0.9 mm，p <0.001)，而后壁厚度无差异。与 PFP 相比，HC 患者的 RWT 更大 (0.68 ± 0.10 与 0.48 ± 0.06，p <0.001)。PFP 的纵向心内膜 ε 和径向心脏 ε 明显高于 HC 患者，而圆周心内膜 ε 则无差异。RWT 是最能准确区分 PFP 和 HC 患者的参数。RWT 切点为 0.6 时，可将 PFP 与 HC 患者区分开来，曲线下面积为 0.97。总之，当室间隔厚度处于 12 至 16 毫米的灰色区域时，二维超声心动图测量 RWT (室间隔+后壁厚度/左心室舒张末期直径) 可准确区分 PFP 与 HC 患者的心脏。二维应变分析确定了灰色区域肥厚的 PFP 与 HC 患者之间心肌变形的变化。
