Department of Cardiology, Gaziantep Training and Research Hospital, 270001, Gaziantep, Turkey.
Department of Cardiology, Gaziantep University, 270001, Gaziantep, Turkey.
Cardiovasc Toxicol. 2018 Apr;18(2):175-183. doi: 10.1007/s12012-017-9428-9.
Carbon monoxide (CO) poisoning could cause significant cardiac injury. This study aimed to evaluate patients with CO poisoning by using speckle tracking echocardiography (STE), a potentially more sensitive technique, to identify left systolic ventricular dysfunction for the first time in the literature. Seventy-two patients who were exposed to CO poisoning were studied. Blood collection and echocardiography were performed at admission and after patients' discharge on days 10-15 (mean 12 days). Global longitudinal strain (GLS) and global circumferential strain (GCS) were calculated using STE. In order to find the normal strain levels and to compare it to the patient with CO poisoning, 35 healthy subjects were included in the study. Left ventricular ejection fraction was analyzed according to Simpson's method. Patients were divided into two groups based on their LVEF values. LVEF < 55%, Group 1 (n = 24); LVEF ≥ 55%, Group 2 (n = 48). The reduction in Group 1 strain levels decreased in correlation with LVEF (p < 0.001) while in Group 2, there were no significant changes in LVEF but strain levels were significantly reduced (p = 0.091; p < 0.001). Compared with the control group patients, admission GLS and GLC values of CO-poisoned patients were significantly low both in Group 1 and 2. On the contrary, no significant difference was observed when compared with follow-up GLS value. For prediction of CO cardiotoxicity, the cutoff value of GLS was ≥ - 19.1 with a sensitivity of 70.3% and a specificity of 100% [(AUC) 0.840, 95% (CI) 0.735-0.916; p < 0.001] in the ROC curve analyses. GLS was found as independent predictors of cardiotoxicity. Our study demonstrates the potential of using systolic strain values obtained using 2D-STE in determining cardiotoxicity due to CO poisoning. Speckle tracking echocardiography has the potential of demonstrating subtle LV systolic dysfunction even in CO poisoning patients with preserved EF.
一氧化碳（CO）中毒可导致严重的心脏损伤。本研究旨在通过使用斑点追踪超声心动图（STE）评估 CO 中毒患者，这是一种潜在更敏感的技术，首次在文献中识别 CO 中毒患者的左心室收缩功能障碍。共研究了 72 例接触 CO 中毒的患者。入院时和入院后 10-15 天（平均 12 天）进行采血和超声心动图检查。使用 STE 计算整体纵向应变（GLS）和整体圆周应变（GCS）。为了找到正常应变水平并与 CO 中毒患者进行比较，纳入了 35 名健康受试者。根据 Simpson 法分析左心室射血分数。根据 LVEF 值将患者分为两组。LVEF < 55%，组 1（n = 24）；LVEF ≥ 55%，组 2（n = 48）。组 1 的应变水平降低与 LVEF 呈负相关（p < 0.001），而在组 2 中，LVEF 无显著变化，但应变水平显著降低（p = 0.091；p < 0.001）。与对照组患者相比，CO 中毒患者入院时 GLS 和 GLC 值在组 1 和 2 中均明显降低。相反，与随访时的 GLS 值相比，无显著差异。对于 CO 心脏毒性的预测，GLS 的截断值为≥-19.1，敏感性为 70.3%，特异性为 100%[（AUC）0.840，95%（CI）0.735-0.916；p < 0.001]，ROC 曲线分析。GLS 是心脏毒性的独立预测因子。本研究表明，使用二维 STE 获得的收缩期应变值在确定 CO 中毒引起的心脏毒性方面具有潜力。斑点追踪超声心动图具有显示 CO 中毒患者即使 EF 保留也存在轻微左心室收缩功能障碍的潜力。
