Galli Elena, Vitel Emilie, Schnell Frédéric, Le Rolle Virginie, Hubert Arnaud, Lederlin Mathieu, Donal Erwan
University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France.
Echocardiography. 2019 Jan;36(1):74-82. doi: 10.1111/echo.14210. Epub 2018 Nov 29.
The estimation of myocardial work by pressure strain loops (PSLs) is a totally new non-invasive approach to assess myocardial performance, and its role in patients with hypertrophic cardiomyopathy is unknown. The aims of the present study are therefore: (a) to compare myocardial work in patients with non-obstructive hypertrophic cardiomyopathy (HCM) and in a subset of age-matched healthy controls and (b) to assess the correlation between myocardial work and left ventricular (LV) fibrosis.
Eighty-two patients with non-obstructive HCM (58 ± 14 years) and 20 age-matched healthy subjects (58 ± 7 years, P = 0.99) underwent standard and speckle-tracking echocardiography to assess myocardial dimensions and deformation parameters. PSLs analysis was used to estimate global myocardial constructive work (GCW) and wasted work (GWW). LV fibrosis was estimated at cardiac magnetic resonance (CMR) by qualitative assessment of late gadolinium enhancement (LGE), and significant fibrosis was defined as LGE in ≥2 LV segments.
Global constructive work (1599 ± 423 vs 2248 ± 249 mm Hg%, P < 0.0001) was significantly reduced in HCM compared to the control group. No difference was observed in GWW (141 ± 125 vs 101 ± 88 mm Hg%, P = 0.18) and LV ejection fraction (LVEF) (63 ± 13 vs 66 ± 4% P = 0.17) between the two groups. In HCM, GCW was the only predictor of LV fibrosis at multivariable analysis (OR 1.01, 95% CI: 0.99-1.08, P = 0.04). A cutoff value of 1623 mm Hg% (AUC 0.80, 95% CI: 0.66-0.93, P < 0.0001) was able to predict myocardial fibrosis with a good sensitivity and fair specificity (82% and 67%, respectively).
Global constructive work is significantly reduced in HCM despite normal LVEF and is associated with the LV fibrosis as assessed by LGE.
通过压力应变环（PSL）评估心肌做功是一种全新的评估心肌功能的非侵入性方法，其在肥厚型心肌病患者中的作用尚不清楚。因此，本研究的目的是：（a）比较非梗阻性肥厚型心肌病（HCM）患者与年龄匹配的健康对照亚组的心肌做功情况；（b）评估心肌做功与左心室（LV）纤维化之间的相关性。
82例非梗阻性HCM患者（58±14岁）和20例年龄匹配的健康受试者（58±7岁，P = 0.99）接受标准和斑点追踪超声心动图检查，以评估心肌尺寸和变形参数。采用PSL分析来估计整体心肌建设性做功（GCW）和废功（GWW）。通过心脏磁共振成像（CMR）对晚期钆增强（LGE）进行定性评估来估计LV纤维化，显著纤维化定义为≥2个LV节段出现LGE。
与对照组相比，HCM患者的整体建设性做功（1599±423 vs 2248±249 mmHg%，P < 0.0001）显著降低。两组之间在GWW（141±125 vs 101±88 mmHg%，P = 0.18）和左心室射血分数（LVEF）（63±13 vs 66±4%，P = 0.17）方面未观察到差异。在HCM中，多变量分析显示GCW是LV纤维化的唯一预测因子（OR 1.01，95% CI：0.99 - 1.08，P = 0.04）。截断值为1623 mmHg%（AUC 0.80，95% CI：0.66 - 0.93，P < 0.0001）能够以良好的敏感性和中等特异性（分别为82%和67%）预测心肌纤维化。
尽管LVEF正常，但HCM患者的整体建设性做功显著降低，且与通过LGE评估的LV纤维化相关。
