Minoshima Makoto, Noda Akiko, Kobayashi Masakazu, Miyata Seiko, Hirashiki Akihiro, Okumura Takahiro, Izawa Hideo, Ishii Hideki, Kondo Takahisa, Murohara Toyoaki
Department of Pathophysiology Laboratory Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Biomedical Sciences, Chubu University Graduate School of Life and Health Sciences, Kasugai, Japan.
J Clin Ultrasound. 2016 Nov 12;44(9):555-560. doi: 10.1002/jcu.22376. Epub 2016 Jul 14.
Myocardial contractile reserve is associated with clinical prognosis in patients with dilated cardiomyopathy (DCM). We assessed myocardial contractile reserve using tissue Doppler strain rate imaging with dobutamine stress echocardiography in DCM patients.
Simultaneous echocardiography and left ventricular (LV) catheterization during dobutamine stress were performed in 20 patients with DCM, and echocardiography was performed in 31 control subjects. Dobutamine was infused at a starting dose of 5 μg/kg/min for 5 minutes and then at 10 μg/kg/min. Peak endomyocardial radial strain (ɛ) and systolic strain rate (SR ) measured with echocardiography and the maximum first derivative of LV pressure (LV dP/dt ) derived from catheterization were used as indices of contractility. Their percentage change from baseline to the dose of 10 μg/kg/min was calculated.
The ɛ and SR were significantly smaller in DCM patients than in controls. The LV dP/dt , ɛ, and SR were significantly higher at the dose of 10 μg/kg/min than at baseline. The percentage change in SR was significantly correlated with the percentage change in LV dP/dt .
Strain rate imaging during dobutamine stress in DCM might prove noninvasively informative for the evaluation of myocardial contractile reserve and provide insight into LV systolic dysfunction. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:555-560, 2016.
心肌收缩储备与扩张型心肌病（DCM）患者的临床预后相关。我们使用多巴酚丁胺负荷超声心动图的组织多普勒应变率成像来评估DCM患者的心肌收缩储备。
对20例DCM患者在多巴酚丁胺负荷期间同时进行超声心动图和左心室（LV）导管插入术，并对31名对照者进行超声心动图检查。多巴酚丁胺以5μg/kg/min的起始剂量输注5分钟，然后以10μg/kg/min输注。用超声心动图测量的峰值心内膜径向应变（ɛ）和收缩期应变率（SR）以及从导管插入术得出的左心室压力最大一阶导数（LV dP/dt）用作收缩性指标。计算它们从基线到10μg/kg/min剂量时的百分比变化。
DCM患者的ɛ和SR显著小于对照组。在10μg/kg/min剂量时的LV dP/dt、ɛ和SR显著高于基线时。SR的百分比变化与LV dP/dt的百分比变化显著相关。
DCM患者多巴酚丁胺负荷期间的应变率成像可能被证明对评估心肌收缩储备具有非侵入性信息，并有助于深入了解左心室收缩功能障碍。©2016威利期刊公司。《临床超声杂志》2016年第44卷：555 - 560页。
