Li Vivian Wing-yi, Cheung Yiu-fai
Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, University of Hong Kong, 102 Pokfulam Road, Hong Kong, China.
Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, University of Hong Kong, 102 Pokfulam Road, Hong Kong, China
Eur Heart J Cardiovasc Imaging. 2015 Jul;16(7):771-80. doi: 10.1093/ehjci/jeu309. Epub 2015 Jan 14.
This study aimed to explore the arterial-left ventricular (LV)-left atrial (LA) interaction in adolescents and young adults late after intervention for coarctation of the aorta (CoA) and interrupted aortic arch (IAA).
Thirty-one (16 males) patients aged 23.4 ± 6.3, at 20.6 ± 5.2 years after intervention, and 31 controls were studied. Carotid arterial stiffness and intima-media thickness (IMT) and brachial-ankle pulse wave velocity were determined by radiofrequency-based echocardiography and oscillometry, respectively. Tissue Doppler and speckle tracking echocardiography (STE) were performed to assess, respectively, LV myocardial tissue velocities and linear and torsional deformation. Left atrial positive, negative, and total strain and strain rate at ventricular systole (aSRs), early diastole (aSRed), and atrial contraction (aSRac) were also determined using STE. Patients had significantly greater arterial stiffness and IMT than controls (all P < 0.05). Mitral annular systolic and diastolic velocities, LV longitudinal and radial strain and early diastolic strain rates, peak torsion and untwisting velocity, and LA peak positive and total strain, aSRs, aSRed, and aSRac were significantly lower in patients than in controls (all P < 0.05). Arterial stiffness correlated inversely with LV longitudinal strain and systolic and early diastolic strain rate (all P < 0.05), while LA total strain and aSRed were associated positively with LV diastolic annular velocity, longitudinal SRe, and peak untwisting velocity (all P < 0.05). Multiple linear regression further revealed arterial stiffness as an independent determinant of LA total strain (β = -1.3, P = 0.034).
Our findings suggest impairment of arterial function and LV and LA mechanics in patients after CoA and IAA repair and implicate an abnormal arterial-LV-LA interaction.
本研究旨在探讨青少年和青年成人在主动脉缩窄（CoA）和主动脉弓中断（IAA）干预治疗后期的动脉-左心室（LV）-左心房（LA）相互作用。
研究了31例（16例男性）患者，干预后20.6±5.2年，年龄23.4±6.3岁，以及31例对照者。分别通过基于射频的超声心动图和示波测量法测定颈动脉僵硬度和内膜中层厚度（IMT）以及臂踝脉搏波速度。进行组织多普勒和斑点追踪超声心动图（STE）分别评估左心室心肌组织速度以及线性和扭转变形。还使用STE测定心室收缩期（aSRs）、舒张早期（aSRed）和心房收缩期（aSRac）时左心房的正应变、负应变和总应变以及应变率。患者的动脉僵硬度和IMT显著高于对照者（均P<0.05）。患者的二尖瓣环收缩期和舒张期速度、左心室纵向和径向应变以及舒张早期应变率、峰值扭转和去扭转速度，以及左心房峰值正应变和总应变、aSRs、aSRed和aSRac均显著低于对照者（均P<0.05）。动脉僵硬度与左心室纵向应变以及收缩期和舒张早期应变率呈负相关（均P<0.05），而左心房总应变和aSRed与左心室舒张期环速度、纵向SRe和峰值去扭转速度呈正相关（均P<0.05）。多元线性回归进一步显示动脉僵硬度是左心房总应变的独立决定因素（β=-1.3，P=0.034）。
我们的研究结果表明，CoA和IAA修复术后患者存在动脉功能以及左心室和左心房力学受损，并提示存在异常的动脉-左心室-左心房相互作用。
