Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway; K.G. Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway.
Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway; K.G. Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway; Bjørknes University College, Oslo, Norway.
Prog Cardiovasc Dis. 2020 Sep-Oct;63(5):552-560. doi: 10.1016/j.pcad.2020.05.007. Epub 2020 Jun 2.
In heart failure (HF) management, noninvasive quantification of left ventricular (LV) function is rapidly evolving. Deformation parameters, such as strain, continue to challenge the central role of ejection fraction (EF) in diagnosis and prognostication of LV dysfunction in HF. The increasing recognition and use of deformation parameters motivates a conceptual discussion about what makes a parameter clinically valuable. To do this, we introduce a framework for parameter evaluation. The framework considers three aspects that are important for parameter value; 1) how these parameters couple with underlying myocardial function; 2) the evidence base of the parameters; and 3) the technical feasibility of their measurement. In particular, we emphasize that the coupling of each parameter to the underlying myocardial function (aspect 1) is crucial for parameter value. While EF offers information about cardiac dysfunction trough measuring changes in LV volume, deformation parameters more closely reflect underlying myocardial processes that contribute to cardiac pumping function. This is a fundamental advantage of deformation parameters that could explain why a growing number of studies supports their use. A close coupling to underlying function is, however, not sufficient for high clinical value by itself. A parameter also needs a strong evidence base (aspect 2) and a high degree of technical feasibility (aspect 3). By considering these three aspects, this review discusses the present and potential clinical value of EF and deformation parameters in HF management.
在心力衰竭（HF）管理中，左心室（LV）功能的无创定量正在迅速发展。应变等变形参数不断挑战射血分数（EF）在 LV 功能障碍诊断和预后中的核心作用。变形参数的日益认识和使用促使我们对什么使参数具有临床价值进行概念性讨论。为此，我们引入了一个参数评估框架。该框架考虑了三个对参数值很重要的方面；1）这些参数与潜在心肌功能的关联；2）参数的证据基础；和 3）其测量的技术可行性。特别是，我们强调每个参数与潜在心肌功能的关联（方面 1）对于参数值至关重要。虽然 EF 通过测量 LV 容积的变化提供了关于心脏功能障碍的信息，但变形参数更紧密地反映了导致心脏泵功能的潜在心肌过程。这是变形参数的一个基本优势，这可以解释为什么越来越多的研究支持其使用。然而，与潜在功能的紧密关联本身并不能保证具有高的临床价值。一个参数还需要有坚实的证据基础（方面 2）和高度的技术可行性（方面 3）。通过考虑这三个方面，本综述讨论了 EF 和变形参数在 HF 管理中的当前和潜在临床价值。
