Amorim Sandra, Rodrigues João, Campelo Manuel, Moura Brenda, Martins Elisabete, Macedo Filipe, Silva-Cardoso J, Maciel M Júlia
Cardiology Department, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
Int J Cardiovasc Imaging. 2017 May;33(5):605-613. doi: 10.1007/s10554-016-1042-6. Epub 2016 Dec 24.
In idiopathic dilated cardiomyopathy (DCM), myocardial deformational parameters and their relationships remain incompletely characterized. We measured those parameters in patients with DCM, during left ventricular reverse remodeling (LVRR). Prospective study of 50 DCM patients (in sinus rhythm), with left ventricular ejection fraction (EF) <40%. LVRR was defined as an increase of ten units of EF and decrease of diastolic left ventricular diameter (LVDD) in the absence of resynchronization therapy. Performed morphological analysis, myocardial performance quantification (LV and RV Tei indexes) and LV averaged peak systolic longitudinal strain (SSR long) and circumferential strain (SSR circ). At baseline, mean EF was 25.4 ± 9.8%, LVDD was 62.4 ± 7.4 mm, LVDD/BSA of 34.2 ± 4.5 mm/m and 34% had MR grade >II/IV. LVRR occurred in 34% of patients within 17.6 ± 15.6 months and was associated with a reduced rate of death or heart failure hospitalization (5.9% vs. 33.3; p = 0.03). Patients with LVRR had a final EF of 48.9 ± 7.9% (Δ LV EF of 22.4%) and there was a significant decrease (p < 0.05) in: LVDD/BSA, LV systolic diameter/BSA, LV diastolic volume, LV systolic volume, LV mass; an increase (p < 0.05) in sphericity index. However, measures of diastolic function (LA volume/BSA, e'velocity and' E/e'ratio), final LV and RV Tei indexes were not significantly different from baseline. Additionally, final SSR circ and SSR long values were not different from basal. Patients who recovered EF >50% (n = 10), SSR circ and SSR long were inferior to normal. Improvement in EF occurred in one-third of DCM pts and was associated with a decrease of major cardiac events. There was an improvement of diastolic and systolic volumes and in sphericity index, confirming truly LV reverse reshaping. However, myocardial performance indexes, SSR long and SSR circ in reverse-remodeled DCM were still abnormal, suggesting a maintained myocardial systolic and diastolic dysfunction.
在特发性扩张型心肌病（DCM）中，心肌变形参数及其关系仍未完全明确。我们在DCM患者左心室逆向重构（LVRR）期间测量了这些参数。对50例DCM患者（窦性心律）进行前瞻性研究，左心室射血分数（EF）<40%。LVRR定义为在未进行再同步治疗的情况下，EF增加10个单位且舒张期左心室直径（LVDD）减小。进行了形态学分析、心肌性能量化（左心室和右心室Tei指数）以及左心室平均收缩期峰值纵向应变（SSR long）和圆周应变（SSR circ）。基线时，平均EF为25.4±9.8%，LVDD为62.4±7.4mm，LVDD/体表面积（BSA）为34.2±4.5mm/m²，34%的患者二尖瓣反流（MR）分级>II/IV。34%的患者在17.6±15.6个月内发生LVRR，且与死亡或心力衰竭住院率降低相关（5.9%对33.3%；p = 0.03）。发生LVRR的患者最终EF为48.9±7.9%（左心室EF增加22.4%），并且在以下方面有显著降低（p<0.05）：LVDD/BSA、左心室收缩直径/BSA、左心室舒张容积、左心室收缩容积、左心室质量；球形指数增加（p<0.05）。然而，舒张功能指标（左心房容积/BSA、e'速度和E/e'比值）、最终左心室和右心室Tei指数与基线相比无显著差异。此外，最终的SSR circ和SSR long值与基础值无差异。EF恢复>50%的患者（n = 10），SSR circ和SSR long低于正常水平。三分之一的DCM患者EF有所改善，且与主要心脏事件减少相关。舒张期和收缩期容积以及球形指数有所改善，证实了真正的左心室逆向重塑。然而，逆向重构的DCM患者的心肌性能指标、SSR long和SSR circ仍异常，提示心肌收缩和舒张功能障碍持续存在。
