应变超声心动图与肥厚型心肌病中的纤维化和室性心律失常相关。

Strain echocardiography is related to fibrosis and ventricular arrhythmias in hypertrophic cardiomyopathy.

作者信息

Haland Trine F, Almaas Vibeke M, Hasselberg Nina E, Saberniak Jørg, Leren Ida S, Hopp Einar, Edvardsen Thor, Haugaa Kristina H

机构信息

Department of Cardiology, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, N-0424 Oslo, Norway Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway University of Oslo, Oslo, Norway Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway.

出版信息

Eur Heart J Cardiovasc Imaging. 2016 Jun;17(6):613-21. doi: 10.1093/ehjci/jew005. Epub 2016 Feb 11.

DOI:10.1093/ehjci/jew005

PMID:26873460

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4871235/

Abstract

AIMS

Hypertrophic cardiomyopathy (HCM) patients are at risk of ventricular arrhythmias (VAs). We aimed to explore whether systolic function by strain echocardiography is related to VAs and to the extent of fibrosis by cardiac magnetic resonance imaging (CMR).

METHODS AND RESULTS

We included 150 HCM patients and 50 healthy individuals. VAs were defined as non-sustained and sustained ventricular tachycardia and aborted cardiac arrest. Left ventricular function was assessed by ejection fraction (EF) and by global longitudinal strain (GLS) assessed by speckle tracking echocardiography. Mechanical dispersion was calculated as standard deviation (SD) of time from Q/R on ECG to peak longitudinal strain in 16 left ventricular segments. Late gadolinium enhancement (LGE) was assessed by CMR. HCM patients had similar EF (61 ± 5% vs. 61 ± 8%, P = 0.77), but worse GLS (-15.7 ± 3.6% vs. -21.1 ± 1.9%, P < 0.001) and more pronounced mechanical dispersion (64 ± 22 vs. 36 ± 13 ms, P < 0.001) compared with healthy individuals. VAs were documented in 37 (25%) HCM patients. Patients with VAs had worse GLS (-14.1 ± 3.6% vs. -16.3 ± 3.4%, P < 0.01), more pronounced mechanical dispersion (79 ± 27 vs. 59 ± 16 ms, P < 0.001), and higher %LGE (6.1 ± 7.8% vs. 0.5 ± 1.4%, P < 0.001) than patients without VAs. Mechanical dispersion correlated with %LGE (R = 0.52, P < 0.001) and was independently associated with VAs (OR 1.6, 95% CI 1.1-2.3, P = 0.02) and improved risk stratification for VAs.

CONCLUSION

GLS, mechanical dispersion, and LGE were markers of VAs in HCM patients. Mechanical dispersion was a strong independent predictor of VAs and related to the extent of fibrosis. Strain echocardiography may improve risk stratification of VAs in HCM.

摘要

目的

肥厚型心肌病（HCM）患者存在室性心律失常（VA）风险。我们旨在探讨应变超声心动图评估的收缩功能是否与VA相关，以及与心脏磁共振成像（CMR）评估的纤维化程度的关系。

方法和结果

我们纳入了150例HCM患者和50名健康个体。VA定义为非持续性和持续性室性心动过速以及心脏骤停未遂。通过射血分数（EF）和斑点追踪超声心动图评估的整体纵向应变（GLS）评估左心室功能。计算机械离散度为心电图上Q/R至16个左心室节段纵向应变峰值的时间标准差（SD）。通过CMR评估延迟钆增强（LGE）。与健康个体相比，HCM患者的EF相似（61±5%对61±8%，P = 0.77），但GLS更差（-15.7±3.6%对-21.1±1.9%，P < 0.001）且机械离散度更明显（64±22对36±13毫秒，P < 0.001）。37例（25%）HCM患者记录有VA。与无VA的患者相比，有VA的患者GLS更差（-14.1±3.6%对-16.3±3.4%，P < 0.01），机械离散度更明显（79±27对59±16毫秒，P < 0.001），且LGE百分比更高（6.1±7.8%对0.5±1.4%，P < 0.001）。机械离散度与LGE百分比相关（R = 0.52，P < 0.001），并与VA独立相关（OR 1.6，95%CI 1.1 - 2.3，P = 0.02），改善了VA的风险分层。