射血分数降低患者中扭转对左心室整体纵向应变的附加价值。

Additive value of torsion to global longitudinal left ventricular strain in patients with reduced ejection fraction.

作者信息

Mornos Cristian, Ruşinaru Dan, Ionac Adina, Petrescu Lucian, Cozma Dragoş, Pescariu Sorin, Drăgulescu Stefan Iosif

机构信息

Cardiology Clinic, Institute of Cardiovascular Diseases, Timişoara, Romania.

出版信息

Acta Cardiol. 2011 Oct;66(5):565-72. doi: 10.1080/ac.66.5.2131080.

DOI:10.1080/ac.66.5.2131080

PMID:22032049

Abstract

BACKGROUND

Torsional and longitudinal deformations are essential components of left ventricular (LV) performance. A precise assessment of LV function must take into account both LV torsion (LVtor) and global longitudinal strain (LVE). We compared a new 2D-strain parameter, LVtor x LVE, with several other echocardiographic parameters, with respect to their strength of association with N-terminal pro-brain natriuretic peptide (NTproBNP) in patients with reduced LV ejection fraction (LVEF).

METHODS

Echocardiography was performed simultaneously with NTproBNP determination in 78 consecutive patients with reduced LVEF (<50%) in sinus rhythm. Early diastolic transmitral velocity/early mitral annular diastolic velocity ratio (E/E') and systolic mitral annular velocity (S') were measured. LVtor was defined as the ratio between LV twist (LVtw) and LV end-diastolic longitudinal length. LVtw (net difference between rotation angles at base and apex) was obtained from parasternal apical and basal short-axis planes. LVE was obtained by averaging longitudinal peak systolic strain of all 17 LV-segments (from apical planes).

RESULTS

Log-transformed NTproBNP correlated significantly with LVE (r = 0.57, P < 0.001), myocardial performance index (r = 0.56, P < 0.001), systolic pulmonary artery pressure (r = 0.47, P < 0.001), E/E' (r = 0.41, P < 0.001), LVtor (r = -0.37, P = 0.001), E-velocity deceleration time (r = -0.37, P = 0.003), S' (r = -0.36, P = 0.002), LVtw (r = -0.34, P = 0.003), LVEF (r = -0.34, P = 0.003), E/A (A = late diastolic transmitral velocity, r = 0.30, P = 0.01) and E (r = 0.28, P = 0.03). LVtor x LVepsilon had the strongest correlation with log-NTproBNP (r = 0.70, P < 0.001). LVtor x LVepsilon was a better predictor of NTproBNP > 900 pg/ml (sensitivity = 82%, specificity = 84%) than other investigated parameters (each P < 0.05).

CONCLUSIONS

In patients with reduced LVEF, LVtor x LVE is a promising parameter that deserves research to establish its clinical meaning and prognostic value.

摘要

背景

扭转和纵向变形是左心室（LV）功能的重要组成部分。对LV功能的精确评估必须同时考虑LV扭转（LVtor）和整体纵向应变（LVE）。我们比较了一种新的二维应变参数LVtor×LVE与其他几个超声心动图参数，就其与左心室射血分数（LVEF）降低患者的N末端脑钠肽前体（NTproBNP）的关联强度而言。

方法

对78例连续的窦性心律LVEF降低（<50%）的患者同时进行超声心动图检查和NTproBNP测定。测量舒张早期二尖瓣血流速度/二尖瓣环舒张早期速度比值（E/E'）和二尖瓣环收缩期速度（S'）。LVtor定义为LV扭转（LVtw）与LV舒张末期纵向长度的比值。LVtw（心底和心尖旋转角度的净差值）从胸骨旁心尖和心底短轴平面获得。LVE通过平均所有17个LV节段（来自心尖平面）的纵向收缩期峰值应变获得。

结果

经对数转换的NTproBNP与LVE（r = 0.57，P < 0.001）、心肌性能指数（r = 0.56，P < 0.001）、收缩期肺动脉压（r = 0.47，P < 0.001）、E/E'（r = 0.41，P < 0.001）、LVtor（r = -0.37，P = 0.001）、E波减速时间（r = -0.37，P = 0.003）、S'（r = -0.36，P = 0.002）、LVtw（r = -0.34，P = 0.003）、LVEF（r = -0.34，P = 0.003）、E/A（A = 舒张晚期二尖瓣血流速度，r = 0.30，P = 0.01）和E（r = 0.28，P = 0.03）显著相关。LVtor×LVepsilon与对数NTproBNP的相关性最强（r = 0.70，P < 0.001）。与其他研究参数相比，LVtor×LVepsilon对NTproBNP>900 pg/ml的预测更好（敏感性 = 82%，特异性 = 84%）（各P < 0.05）。