心力衰竭时左心室流体动力学：超声心动图测量和涡形成时间的应用。
Left ventricular fluid dynamics in heart failure: echocardiographic measurement and utilities of vortex formation time.
机构信息
Cardiac Department, National University Heart Center, 1E, Kent Ridge Road, NUHS Tower Block, Level 9, Singapore 119228, Singapore.
出版信息
Eur Heart J Cardiovasc Imaging. 2012 May;13(5):385-93. doi: 10.1093/ejechocard/jer288. Epub 2011 Dec 16.
BACKGROUND
In clinical heart failure (HF), inefficient propagation of blood through the left ventricle (LV) may result from suboptimal vortex formation (VF) ability of the LV during early diastole. We aim to (i) validate echocardiographic-derived vortex formation time (adapted) (VFTa) in control subjects and (ii) examine its utility in both systolic and diastolic HF.
METHODS
Transthoracic echocardiography was performed in 32 normal subjects and in 130 patients who were hospitalized with HF [91, reduced ejection fraction (rEF) and 39, preserved ejection fraction (pEF)]. In addition to biplane left ventricular ejection fraction (LVEF) and conventional parameters, the Tei index and tissue Doppler (TD) indices were measured. VFTa was obtained using the formula: 4 × (1 - β)/π × α³ × LVEF, where β is the fraction of total transmitral diastolic stroke volume contributed by atrial contraction (assessed by time velocity integral of the mitral E- and A-waves) and α is the biplane end-diastolic volume (EDV)(1/3) divided by mitral annular diameter during early diastole. VFTa was correlated with demographic, cardiac parameters, and a composite clinical endpoint comprising cardiac death and repeat hospitalization for HF.
RESULTS
Mean VFTa was 2.67 ± 0.8 in control subjects; reduced in HF, preserved EF HF, 2.21 ± 0.8; HF with reduced EF, 1.25 ± 0.6 (P< 0.001). It was not affected by age, gender, body surface area but was correlated positively with TD early diastolic myocardial velocities (E', septal, r = 0.46; lateral, r = 0.43), systolic myocardial velocities (S', septal, r = 0.47; lateral, r = 0.41), and inversely with the Tei index (r = -0.41); all Ps < 0.001. Sixty-two HF patients (49%) met the composite endpoint. VFTa of <1.32 was associated with significantly reduced event-free survival (Kaplan Meier log rank = 16.3, P= 0.0001) and predicted the endpoint with a sensitivity and specificity of 65 and 72%, respectively.
CONCLUSION
VFTa, a dimensionless index, incorporating LV geometry, systolic and diastolic parameters, may be useful in the diagnosis and prognosis of HF.
背景
在临床心力衰竭（HF）中，左心室（LV）内血液的低效传播可能是由于LV 在舒张早期形成涡旋的能力不理想所致。我们的目的是：（i）验证超声心动图衍生的左心室早期舒张涡旋形成时间（适应）（VFTa）在对照人群中的适用性，以及（ii）研究其在收缩性和舒张性 HF 中的应用价值。
方法
对 32 名正常受试者和 130 名因 HF 住院的患者（91 名射血分数降低（rEF）和 39 名射血分数保留（pEF）HF）进行经胸超声心动图检查。除了双平面左心室射血分数（LVEF）和常规参数外，还测量了 Tei 指数和组织多普勒（TD）指数。VFTa 通过以下公式获得：4×（1-β）/π×α³×LVEF，其中β是由心房收缩贡献的总二尖瓣舒张期射血量的分数（通过二尖瓣 E 和 A 波的时间速度积分评估），α是双平面舒张末期容积（EDV）（1/3）除以舒张早期二尖瓣环直径。VFTa 与人口统计学、心脏参数以及包括心脏死亡和 HF 再住院的复合临床终点相关。
结果
对照组的平均 VFTa 为 2.67±0.8；HF 时降低，HF 保留 EF 时为 2.21±0.8；HF 射血分数降低时为 1.25±0.6（P<0.001）。它不受年龄、性别、体表面积的影响，但与 TD 早期舒张心肌速度（E'，间隔，r=0.46；侧壁，r=0.43）、收缩期心肌速度（S'，间隔，r=0.47；侧壁，r=0.41）呈正相关，与 Tei 指数呈负相关（r=-0.41）；所有 P 值均<0.001。62 例 HF 患者（49%）符合复合终点。VFTa<1.32 与显著降低的无事件生存相关（Kaplan Meier 对数秩检验=16.3，P=0.0001），并具有 65%的敏感性和 72%的特异性来预测终点。
结论
VFTa 是一个无量纲指数，包含 LV 几何形状、收缩和舒张参数，可能对 HF 的诊断和预后有用。
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