Friedberg Mark K, Margossian Renee, Lu Minmin, Mercer-Rosa Laura, Henderson Heather T, Nutting Arni, Friedman Kevin, Molina Kimberly M, Altmann Karen, Canter Charles, Sleeper Lynn A, Colan Steven D
Hospital for Sick Children, Toronto, Ontario, Canada;
Boston Children's Hospital, Boston, Massachusetts;
J Appl Physiol (1985). 2016 Jun 1;120(11):1301-18. doi: 10.1152/japplphysiol.00635.2015. Epub 2016 Mar 3.
Systolic and diastolic function affect dilated cardiomyopathy (DCM) outcomes. However, systolic-diastolic coupling, as a distinct characteristic, may itself affect function but is poorly characterized. We hypothesized that echocardiographic left ventricular (LV) longitudinal systolic tissue velocities (S') correlate with diastolic longitudinal velocities (E') and that their relationship is associated with ventricular function and that this relationship is impaired in pediatric DCM. We analyzed data from the Pediatric Heart Network Ventricular Volume Variability study, using linear regression and generalized additive modeling to assess relationships between S' and E' at the lateral and septal mitral annulus. We explored relationships between the systolic:diastolic (S:D) coupling ratio (S':E' relative to age) and ventricular function. Up to 4 echocardiograms from 130 DCM patients (mean age: 9.3 ± 6.1 yr) and 1 echocardiogram from each of 591 healthy controls were analyzed. S' and E' were linearly related in controls (r = 0.64, P < 0.001) and DCM (r = 0.83, P < 0.001). In DCM, the magnitude of association between S' and E' was reduced with progressive ventricular remodeling. The S:D ratio was more strongly associated with LV function in controls vs. DCM. The septal S:D ratio was higher (presumed worse) in DCM vs. controls (0.69 ± 0.13 vs. 0.62 ± 0.12, P = 0.001). A higher septal S:D ratio was associated with worse LV dimensions (parameter estimate: 0.0061, P = 0.004), mass (parameter estimate: 0.0074, P = 0.002), ejection fraction (parameter estimate: -0.0303, P = 0.024), and inflow propagation (parameter estimate: -0.3538, P < .001). S:D coupling becomes weaker in DCM with LV remodeling and dysfunction. The S:D coupling ratio may be useful to assess coupling, warranting study in relation to patient outcomes.
收缩功能和舒张功能会影响扩张型心肌病（DCM）的预后。然而，作为一个独特特征的收缩 - 舒张耦联本身可能会影响心脏功能，但目前对其特征的描述尚不充分。我们推测，超声心动图测量的左心室（LV）纵向收缩期组织速度（S'）与舒张期纵向速度（E'）相关，且它们之间的关系与心室功能有关，并且这种关系在儿童DCM中受损。我们分析了来自儿科心脏网络心室容积变异性研究的数据，使用线性回归和广义相加模型来评估二尖瓣环外侧和间隔处S'与E'之间的关系。我们探讨了收缩期：舒张期（S:D）耦联比（相对于年龄的S':E'）与心室功能之间的关系。分析了130例DCM患者（平均年龄：9.3±6.1岁）的多达4次超声心动图检查结果以及591名健康对照者每人的1次超声心动图检查结果。在对照组（r = 0.64，P < 0.001）和DCM组（r = 0.83，P < 0.001）中，S'与E'呈线性相关。在DCM中，随着心室重塑的进展，S'与E'之间的关联强度降低。与DCM相比，对照组中S:D比与左心室功能的相关性更强。DCM组的间隔S:D比高于对照组（假定更差）（0.69±0.13 vs. 0.62±0.12，P = 0.001）。较高的间隔S:D比与更差的左心室尺寸（参数估计值：0.0061，P = 0.004）、质量（参数估计值：0.0074，P = 0.002）、射血分数（参数估计值： - 0.0303，P = 0.024）和血流传播（参数估计值： - 0.3538，P < 0.001）相关。随着左心室重塑和功能障碍，DCM中的S:D耦联变得更弱。S:D耦联比可能有助于评估耦联情况，有必要针对患者预后进行研究。
