Mechelinck Mare, Hartmann Bianca, Hamada Sandra, Becker Michael, Andert Anne, Ulmer Tom Florian, Neumann Ulf Peter, Wirtz Theresa Hildegard, Koch Alexander, Trautwein Christian, Roehl Anna Bettina, Rossaint Rolf, Hein Marc
Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany.
Department of Internal Medicine I, Cardiology, Angiology and Internal Intensive Care Medicine, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany.
J Clin Med. 2020 Aug 12;9(8):2616. doi: 10.3390/jcm9082616.
Speckle tracking echocardiography enables the detection of subclinical left ventricular dysfunction at rest in many heart diseases and potentially in severe liver diseases. It could also possibly serve as a predictor for survival. In this study, 117 patients evaluated for liver transplantation in a single center between May 2010 and April 2016 with normal left ventricular ejection fraction were included according to clinical characteristics of their liver disease: (1) compensated ( = 29), (2) clinically significant portal hypertension ( = 49), and (3) decompensated ( = 39). Standard echocardiography and speckle tracking echocardiography were performed at rest and during dobutamine stress. Follow-up amounted to three years to evaluate survival and major cardiac events. Altogether 67% (78/117) of the patients were transplanted and 32% (31/96 patients) died during the three-year follow-up period. Global longitudinal strain (GLS) at rest was significantly increased (became more negative) with the severity of liver disease ( < 0.001), but reached comparable values in all groups during peak stress. Low (less negative) GLS values at rest (male: >-17/female: >-18%) could predict patient survival in a multivariate Cox regression analysis ( = 0.002). GLS proved valuable in identifying transplant candidates with latent systolic dysfunction.
斑点追踪超声心动图能够在多种心脏病甚至可能在严重肝病患者静息状态下检测到亚临床左心室功能障碍。它还可能作为生存的预测指标。在本研究中，根据肝病的临床特征，纳入了2010年5月至2016年4月在单一中心接受肝移植评估且左心室射血分数正常的117例患者：（1）代偿期（n = 29），（2）具有临床意义的门静脉高压（n = 49），以及（3）失代偿期（n = 39）。在静息状态和多巴酚丁胺负荷试验期间进行标准超声心动图和斑点追踪超声心动图检查。随访三年以评估生存率和主要心脏事件。在三年随访期内，共有67%（78/117）的患者接受了移植，32%（31/96例患者）死亡。静息状态下的整体纵向应变（GLS）随着肝病严重程度的增加而显著升高（变得更负）（P < 0.001），但在负荷峰值时所有组的值相当。在多因素Cox回归分析中，静息状态下较低（较不负）的GLS值（男性：> -17%/女性：> -18%）可预测患者生存（P = 0.002）。GLS在识别具有潜在收缩功能障碍的肝移植候选者方面被证明具有价值。
