Gabrielli Luigi, Enríquez Andrés, Córdova Samuel, Yáñez Fernando, Godoy Iván, Corbalán Ramon
Cardiovascular Diseases Division, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
Echocardiography. 2012 Sep;29(8):943-9. doi: 10.1111/j.1540-8175.2012.01719.x. Epub 2012 May 29.
Hypertrophic cardiomyopathy (HCM) is a common cause of sudden death in athletes and differentiating this condition from the nonpathological "athlete's heart" remains a challenge. The development of pathological left ventricular hypertrophy (LVH) is associated with left atrial (LA) dilatation and dysfunction. LA strain and strain rate by two-dimensional (2D) speckle tracking are novel indices of LA function and might contribute to differentiate physiological from pathological LVH among athletes with underdiagnosed HCM.
We evaluated 20 patients with nonobstructive HCM, 20 highly trained athletes and 20 healthy controls matched for age, gender, and body surface area. All patients underwent a transthoracic echocardiogram with evaluation of LA strain: s-wave (LASs); and strain rate: s-wave (LASRs) and a-wave (LASRa).
LV mass index, LA volume index, and ejection fraction were comparable between patients with HCM and athletes. Patients with HCM had a significantly lower LASs (19 + 8% vs. 43 + 8%, P < 0.01), LASRs (0.7 + 0.2 s-1 vs. 1.6 + 0.2 s-1, P < 0.01), and LASRa (-0.8 + 0.1 s-1 vs. -1.4 + 0.3 s-1, P < 0.01) compared to athletes. Among hypertrophic subjects, independent predictors of hypertrophy related to HCM were LASs and E/é ratio.
LA myocardial deformation is significantly impaired in patients with HCM compared to athletes and healthy controls. LA strain and strain rate assessed by 2D speckle tracking should be incorporated in the evaluation of trained athletes with LVH and LA dilatation.
肥厚型心肌病（HCM）是运动员猝死的常见原因，将这种疾病与非病理性的“运动员心脏”区分开来仍然是一项挑战。病理性左心室肥厚（LVH）的发展与左心房（LA）扩张和功能障碍有关。二维（2D）斑点追踪测量的左心房应变和应变率是左心房功能的新指标，可能有助于在未被充分诊断为HCM的运动员中区分生理性与病理性LVH。
我们评估了20例非梗阻性HCM患者、20名训练有素的运动员以及20名年龄、性别和体表面积相匹配的健康对照者。所有患者均接受经胸超声心动图检查并评估左心房应变：s波（LASs）；以及应变率：s波（LASRs）和a波（LASRa）。
HCM患者与运动员之间的左心室质量指数、左心房容积指数和射血分数相当。与运动员相比，HCM患者的LASs显著降低（19 + 8% 对 43 + 8%，P < 0.01），LASRs（0.7 + 0.2 s-1 对 1.6 + 0.2 s-1，P < 0.01），以及LASRa（-0.8 + 0.1 s-1 对 -1.4 + 0.3 s-1，P < 0.01）。在肥厚型受试者中，与HCM相关的肥厚独立预测因素是LASs和E/é比值。
与运动员和健康对照者相比，HCM患者的左心房心肌变形明显受损。二维斑点追踪评估的左心房应变和应变率应纳入对有LVH和左心房扩张的训练有素运动员的评估中。
