Department of Cardiology, Icahn School of Medicine at Mount Sinai University, New York, New York; Department of Internal Medicine, Medical Division, National Research Centre, Cairo, Egypt.
Department of Cardiology, Icahn School of Medicine at Mount Sinai University, New York, New York.
JACC Cardiovasc Imaging. 2017 Nov;10(11):1291-1303. doi: 10.1016/j.jcmg.2016.10.012. Epub 2017 Jan 18.
The aim of this study was to investigate whether cluster analysis of left atrial and left ventricular (LV) mechanical deformation parameters provide sufficient information for Doppler-independent assessment of LV diastolic function.
Medical imaging produces substantial phenotyping data, and superior computational analyses could allow automated classification of repetitive patterns into patient groups with similar behavior.
The authors performed a cluster analysis and developed a model of LV diastolic function from an initial exploratory cohort of 130 patients that was subsequently tested in a prospective cohort of 44 patients undergoing cardiac catheterization. Patients in both study groups had standard echocardiographic examination with Doppler-derived assessment of diastolic function. Both the left ventricle and the left atrium were tracked simultaneously using speckle-tracking echocardiography (STE) for measuring simultaneous changes in left atrial and ventricular volumes, volume rates, longitudinal strains, and strain rates. Patients in the validation group also underwent invasive measurements of pulmonary capillary wedge pressure and LV end diastolic pressure immediately after echocardiography. The similarity between STE and conventional 2-dimensional and Doppler methods of diastolic function was investigated in both the exploratory and validation cohorts.
STE demonstrated strong correlations with the conventional indices and independently clustered the patients into 3 groups with conventional measurements verifying increasing severity of diastolic dysfunction and LV filling pressures. A multivariable linear regression model also allowed estimation of E/e' and pulmonary capillary wedge pressure by STE in the validation cohort.
Tracking deformation of the left-sided cardiac chambers from routine cardiac ultrasound images provides accurate information for Doppler-independent phenotypic characterization of LV diastolic function and noninvasive assessment of LV filling pressures.
本研究旨在探讨左心房和左心室（LV）机械变形参数的聚类分析是否能为多普勒独立评估 LV 舒张功能提供充分信息。
医学影像学产生了大量的表型数据，而更高级的计算分析可以允许将重复模式自动分类为具有相似行为的患者组。
作者进行了聚类分析，并从最初的 130 例探索性队列中建立了一个 LV 舒张功能模型，随后在 44 例行心导管检查的前瞻性队列中进行了测试。两组患者均进行标准超声心动图检查，采用多普勒评估舒张功能。使用斑点追踪超声心动图（STE）同时对左心房和心室容积、容积率、纵向应变和应变率进行同步测量，以同时跟踪左心室和左心房。验证组的患者还在超声心动图后立即进行了肺毛细血管楔压和 LV 舒张末期压力的有创测量。在探索性和验证性队列中，研究了 STE 与传统二维和多普勒舒张功能方法之间的相似性。
STE 与传统指数具有很强的相关性，并独立地将患者聚类为 3 组，传统测量验证了舒张功能障碍和 LV 充盈压逐渐加重。多变量线性回归模型也允许在验证队列中通过 STE 估计 E/e'和肺毛细血管楔压。
从常规心脏超声图像中跟踪左心腔的变形可提供准确的信息，用于多普勒独立的 LV 舒张功能表型特征描述和 LV 充盈压的无创评估。
