Schnell Frédéric, Matelot David, Daudin Magalie, Kervio Gaelle, Mabo Philippe, Carré François, Donal Erwan
Department of Sport Medicine, Pontchaillou Hospital, Department of Physiology, Rennes1 University, Rennes, France; INSERM UMR 1099, Rennes, France.
INSERM UMR 1099, Rennes, France.
J Am Soc Echocardiogr. 2017 Mar;30(3):251-261. doi: 10.1016/j.echo.2016.11.013. Epub 2017 Jan 5.
Previous studies have demonstrated that global longitudinal strain (GLS) is altered in patients with hypertrophic cardiomyopathy (HCM) in comparison with athletes. Nevertheless, these results rely on studies comparing sedentary patients with HCM with healthy athletes. The aims of this study were to confirm these findings in an appropriate group of athletes with HCM and to study the additive value of novel parameters (i.e., mechanical dispersion and exercise GLS).
Thirty-six athletes with HCM were prospectively included and were compared with 36 sedentary patients with HCM, 36 healthy athletes, and 36 sedentary control subjects of similar age. Athlete groups had similar training duration and HCM groups similar maximal wall thickness. All underwent echocardiography at rest and during submaximal exercise. GLS was assessed; the SD of time to maximal myocardial shortening of longitudinal strain was calculated as a parameter of mechanical dispersion.
The HCM sedentary group showed the lowest resting and exercise GLS. Resting GLS was not different between athletes with HCM and the two control groups, but exercise GLS enabled the differentiation of athletes with HCM from healthy athletes. Mechanical dispersion was higher in both HCM groups compared with both control groups at rest and during exercise. Receiver operating characteristic analysis in the athlete groups demonstrated that resting mechanical dispersion (area under the curve = 0.949 ± 0.023) had better ability to identify HCM compared with GLS at rest (area under the curve = 0.644 ± 0.069) (P < .001) or during exercise (area under the curve = 0.706 ± 0.066) (P < .005).
In athletes, normal resting GLS does not rule out the diagnosis of HCM. Mechanical dispersion of longitudinal strain seems to be a promising tool for the diagnosis of HCM in athletes.
既往研究表明，与运动员相比，肥厚型心肌病（HCM）患者的整体纵向应变（GLS）发生改变。然而，这些结果依赖于将久坐不动的HCM患者与健康运动员进行比较的研究。本研究的目的是在一组合适的HCM运动员中证实这些发现，并研究新参数（即机械离散度和运动GLS）的附加价值。
前瞻性纳入36例HCM运动员，并与36例久坐不动的HCM患者、36例健康运动员以及36例年龄相仿的久坐不动的对照受试者进行比较。运动员组的训练时长相似，HCM组的最大室壁厚度相似。所有人均在静息状态和次极量运动期间接受超声心动图检查。评估GLS；计算纵向应变最大心肌缩短时间的标准差作为机械离散度参数。
久坐不动的HCM组静息和运动时的GLS最低。HCM运动员与两个对照组之间静息GLS无差异，但运动GLS能够区分HCM运动员与健康运动员。在静息和运动期间，两个HCM组的机械离散度均高于两个对照组。运动员组的受试者工作特征分析表明，静息机械离散度（曲线下面积=0.949±0.023）比静息GLS（曲线下面积=0.644±0.069）（P<.001）或运动时GLS（曲线下面积=0.706±0.066）（P<.005）具有更好的识别HCM的能力。
在运动员中，静息GLS正常不能排除HCM的诊断。纵向应变的机械离散度似乎是诊断运动员HCM的一种有前景的工具。
