Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
Pulmonology Unit, ASST Spedali Civili of Brescia, Brescia, Italy.
Intern Emerg Med. 2019 Nov;14(8):1279-1285. doi: 10.1007/s11739-019-02104-5. Epub 2019 May 14.
Strain echocardiography is able to detect subclinical ventricular systolic and diastolic dysfunction. Prolonged survival to cystic fibrosis favors heart and vessel involvement. The purpose of the present study was to compare clinically stable adult patients affected by cystic fibrosis without overt pulmonary hypertension with controls to evaluate right ventricular (RV) systolic and diastolic function by means of strain and tissue Doppler imaging (TDI), respectively. 22 adults affected by cystic fibrosis and 24 healthy volunteers matched for age and sex were enrolled. None had known cardiovascular risk factors or overt pulmonary hypertension. All people underwent blood pressure measurement and transthoracic echocardiography. Cystic fibrosis patients showed higher sPAP [median 25 (IQR 21-30) vs 22 (22-22) mmHg; p = 0.02] and more frequent RV diastolic dysfunction (p < 0.001). Among cases, some RV systolic parameters were significantly altered than controls, such as TAPSE [20 (18-24) vs. 23 (21-28) mm; p = 0.001], FAC [34 (26-44) vs. 49 (48-50)%; p < 0.001], midwall tissue strain [- 25.0 (- 31.3 to - 22.8) vs. - 30.5 (- 31.8 to - 29.3)%; p = 0.03], apical tissue strain [- 22 (- 29.3 to - 19.0) vs. - 30.5 (- 32.8 to - 28.3)%; p = 0.001] and 2D strain [- 22.0 (- 25.1 to - 19.0) vs. - 29.5 (- 31.8 to - 27.3)%; p < 0.001]. Finally, 2D strain correlated with spirometric FEV1 (ρ = - 0.463, p = 0.03) and nearly with FEF25-75% (ρ = - 0.393, p = 0.07). Our study confirmed a RV subclinical systo-diastolic dysfunction in clinically stable patients affected by cystic fibrosis without overt pulmonary hypertension nor cardiovascular risk factors. This may be due to systemic inflammation and temporary recurrent pulmonary hypertension. We retain that RV 2D strain and TDI echocardiography could become an important tool in the follow-up of these patients.
应变超声心动图能够检测亚临床心室收缩和舒张功能障碍。囊性纤维化患者的长期生存有利于心脏和血管受累。本研究的目的是比较无明显肺动脉高压的囊性纤维化成年患者和对照组，分别通过应变和组织多普勒成像（TDI）评估右心室（RV）收缩和舒张功能。共纳入 22 例囊性纤维化患者和 24 例年龄和性别匹配的健康志愿者。所有患者均行血压测量和经胸超声心动图检查。囊性纤维化患者的 sPAP 更高[中位数 25（IQR 21-30）比 22（22-22）mmHg；p=0.02]，且更常出现 RV 舒张功能障碍（p<0.001）。在病例组中，一些 RV 收缩参数与对照组相比发生了显著变化，例如 TAPSE[20（18-24）比 23（21-28）mm；p=0.001]、FAC[34（26-44）比 49（48-50）%；p<0.001]、中层组织应变[-25.0（-31.3 至-22.8）比-30.5（-31.8 至-29.3）%；p=0.03]、心尖组织应变[-22（-29.3 至-19.0）比-30.5（-32.8 至-28.3）%；p=0.001]和 2D 应变[-22.0（-25.1 至-19.0）比-29.5（-31.8 至-27.3）%；p<0.001]。最后，2D 应变与肺量计 FEV1 呈负相关（ρ=-0.463，p=0.03），与 FEF25-75% 几乎呈负相关（ρ=-0.393，p=0.07）。我们的研究证实，在无明显肺动脉高压和心血管危险因素的临床稳定囊性纤维化患者中，存在 RV 亚临床收缩-舒张功能障碍。这可能是由于全身炎症和暂时反复发作的肺动脉高压所致。我们认为 RV 二维应变和 TDI 超声心动图可能成为这些患者随访的重要工具。
