van Dalen Bas M, Tzikas Apostolos, Soliman Osama I I, Heuvelman Helena J, Vletter Wim B, Ten Cate Folkert J, Geleijnse Marcel L
Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands.
Echocardiography. 2013 Mar;30(3):293-300. doi: 10.1111/echo.12051. Epub 2013 Jan 24.
Angina and an electrocardiographic strain pattern are potential manifestations of subendocardial ischemia in aortic stenosis (AS). Left ventricular (LV) twist is known to increase proportionally to the severity of AS, which may be a result of loss of the inhibiting effect of the subendocardial fibers due to subendocardial dysfunction. It has also been shown that the ratio of LV twist to circumferential shortening of the endocardium (twist-to-shortening ratio [TSR]) is a reliable parameter of subendocardial dysfunction. The aim of this study was to investigate whether these markers are increased in AS patients with angina and/or electrocardiographic strain.
The study comprised 60 AS patients with an aortic valve area <2.0 cm(2) and LV ejection fraction >50%, and 30 healthy-for age and gender matched-control subjects. LV rotation parameters were determined by speckle tracking echocardiography.
Comparison of patients without angina and strain (n = 22), with either angina or strain (n = 28), and with both angina and strain (n = 8), showed highest peak systolic LV apical rotation, peak systolic LV twist, and TSR, in patients with more signs of subendocardial ischemia. In a multivariate linear regression model, only severity of AS and the presence of angina and/or strain could be identified as independent predictors of peak systolic LV twist and TSR.
Peak systolic LV twist and TSR are increased in AS patients and related to the severity of AS and symptoms (angina) or electrocardiographic signs (strain) compatible with subendocardial ischemia.
心绞痛和心电图应变模式是主动脉瓣狭窄（AS）时心内膜下缺血的潜在表现。已知左心室（LV）扭转与AS的严重程度成比例增加，这可能是由于心内膜下功能障碍导致心内膜下纤维抑制作用丧失的结果。也有研究表明，LV扭转与心内膜圆周缩短率的比值（扭转缩短率[TSR]）是心内膜下功能障碍的可靠参数。本研究的目的是调查这些标志物在伴有心绞痛和/或心电图应变的AS患者中是否升高。
本研究纳入60例主动脉瓣面积<2.0 cm²且左心室射血分数>50%的AS患者，以及30例年龄和性别匹配的健康对照者。通过斑点追踪超声心动图测定左心室旋转参数。
比较无心绞痛和应变的患者（n = 22）、有心绞痛或应变的患者（n = 28）以及同时有心绞痛和应变的患者（n = 8），发现心内膜下缺血迹象更多的患者，其左心室收缩期峰值心尖旋转、左心室收缩期峰值扭转和TSR最高。在多变量线性回归模型中，只有AS的严重程度以及心绞痛和/或应变的存在可被确定为左心室收缩期峰值扭转和TSR的独立预测因素。
AS患者的左心室收缩期峰值扭转和TSR升高，且与AS的严重程度以及与心内膜下缺血相符的症状（心绞痛）或心电图征象（应变）相关。
