Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois.
JAMA Cardiol. 2019 Mar 1;4(3):287-294. doi: 10.1001/jamacardio.2019.0052.
The cornerstones of imaging in heart failure (HF) are the measurement of systolic and diastolic function and left ventricular (LV) filling pressure.
Ejection fraction and the assessment of LV filling pressure and diastolic dysfunction using the ratio of early transmitral flow and LV relaxation (E/e') are conventional imaging markers of LV function. Despite their extensive use in HF guidelines, both have significant detractions, especially in an era when HF with preserved ejection fraction is becoming the dominant presentation. In contrast, strain imaging has provided a new window into myocardial mechanics. Myocardial strain is now well validated, robust, and can easily be performed on most modern echocardiography machines. This Review summarizes the evidence in 9 situations across the stages of HF where LV global longitudinal strain and other strain parameters may provide information on risk prediction, diagnosis, assessment of treatment response, and follow-up.
The evolution of myocardial deformation imaging from research tool to clinical practice will provide clinicians with a useful additional imaging parameter to facilitate the assessment and risk evaluation of patients with HF.
心力衰竭（HF）的影像学基础是收缩和舒张功能以及左心室（LV）充盈压的测量。
射血分数以及使用二尖瓣早期血流和 LV 松弛的比值（E/e'）评估 LV 充盈压和舒张功能障碍是 LV 功能的常规影像学标志物。尽管它们在 HF 指南中被广泛应用，但都有明显的缺陷，尤其是在 HF 射血分数保留的时代，这种情况已成为主要表现。相比之下，应变成像为心肌力学提供了一个新的视角。心肌应变现在已经得到了很好的验证，具有稳健性，并且可以很容易地在大多数现代超声心动图机上进行。这篇综述总结了在 HF 的 9 个阶段中，LV 整体纵向应变和其他应变参数在风险预测、诊断、治疗反应评估和随访方面提供信息的证据。
心肌变形成像从研究工具到临床实践的发展将为临床医生提供一个有用的附加影像学参数，以促进 HF 患者的评估和风险评估。
