Cho Eun Jeong, Park Sung-Ji, Kim Eun Kyoung, Lee Ga Yeon, Chang Sung-A, Choi Jin-Oh, Lee Sang-Chol, Park Seung Woo
Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Division of Cardiology, Department of Internal Medicine, National Cancer Center, Goyang, Korea.
Echocardiography. 2017 Apr;34(4):511-522. doi: 10.1111/echo.13474. Epub 2017 Mar 23.
The aim of this study was to determine the capability of real time three-dimensional echocardiography (RT3DE) and two-dimensional (2D) multilayer speckle tracking echocardiography (MSTE) for evaluation of early myocardial dysfunction triggered by increased left ventricular (LV) wall thickness in severe aortic stenosis (AS) with normal LV ejection fraction (EF≥55%).
Conventional, RT3D STE and 2D MSTE were performed in 45 patients (mean 68.9±9.0 years) with severe AS (aortic valve area <1 cm , aortic velocity Vmax >4 m/s or mean PG >40 mm Hg) and normal left ventricular ejection fraction (LVEF) without overt coronary artery disease and in 18 age-, sex-matched healthy controls. Global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) were calculated using RT3DE and MSTE.
The severe AS group had lower 3D GLS, GRS, GAS and 2D epicardium, and mid-wall and endocardium GLS compared to healthy controls. In MSTE analysis, 2D LS and CS values decreased from the endocardial layer toward the epicardial layer. Severe AS patients with increased LV wall thickness had lower 3D GLS and 2D epicardium, and mid-wall and endocardium GLS compared with severe AS patients without LV wall thickening. GLS on RT3D STE was correlated with GLS on 2D MSTE, left ventricular mass index, LVEF, left atrial volume index, and lnNT-proBNP.
RT3DE and 2D MSTE can be used to identify subtle contractile dysfunction triggered by increased LV wall thickness in severe AS with normal LVEF. Therefore, RT3D STE and 2D MSTE may provide additional information that can facilitate decision-making regarding severe AS patients with increased LV wall thickness and normal LV function.
本研究旨在确定实时三维超声心动图（RT3DE）和二维（2D）多层斑点追踪超声心动图（MSTE）评估左心室射血分数正常（EF≥55%）的严重主动脉瓣狭窄（AS）患者因左心室（LV）壁厚度增加引发的早期心肌功能障碍的能力。
对45例（平均年龄68.9±9.0岁）严重AS（主动脉瓣面积<1 cm²，主动脉流速Vmax>4 m/s或平均跨瓣压差>40 mmHg）且左心室射血分数（LVEF）正常、无明显冠状动脉疾病的患者以及18例年龄和性别匹配的健康对照者进行常规、RT3D STE和2D MSTE检查。使用RT3DE和MSTE计算整体纵向应变（GLS）、整体圆周应变（GCS）、整体面积应变（GAS）和整体径向应变（GRS）。
与健康对照者相比，严重AS组的三维GLS、GRS、GAS以及二维心外膜、中层心肌和心内膜GLS均较低。在MSTE分析中，二维LS和CS值从心内膜层向心外膜层降低。与无LV壁增厚的严重AS患者相比，LV壁增厚的严重AS患者的三维GLS以及二维心外膜、中层心肌和心内膜GLS较低。RT3D STE上的GLS与二维MSTE上的GLS、左心室质量指数、LVEF、左心房容积指数和lnNT-proBNP相关。
RT3DE和2D MSTE可用于识别LVEF正常的严重AS患者因LV壁厚度增加引发的细微收缩功能障碍。因此，RT3D STE和2D MSTE可能提供额外信息，有助于对LV壁厚度增加且LV功能正常的严重AS患者做出决策。
