Minatoguchi Shingo, Yoshizane Takashi, Tanaka Ryuhei, Iwama Makoto, Watanabe Takatomo, Sato Hidemaro, Nagaya Maki, Ono Koji, Noda Toshiyuki, Watanabe Sachiro, Minatoguchi Shinya, Kawasaki Masanori
Department of Cardiology, Gifu University Graduate School of Medicine Gifu Japan.
Department of Cardiology, Gifu Prefectural General Medical Center Gifu Japan.
Circ Rep. 2019 Feb 2;1(2):78-86. doi: 10.1253/circrep.CR-19-0001.
Left ventricular (LV) torsion by contraction of inner and outer oblique muscles contributes to EF. Outer muscle plays a predominant role in torsion. We evaluated the impact of LV remodeling by hypertension (HTN) on torsion using 3-dimensional speckle tracking echocardiography (3D-STE). LV strain, strain rate during systole (SR-S) and torsion at endocardium, mid-wall and epicardium were assessed on 3D-STE in 53 controls and 186 HTN patients. Torsion was defined as the difference between apical and basal rotation divided by long axis length. LVEF and strain, SR-S and torsion in all 3 layers in HTN without LV hypertrophy (LVH) were similar to those in controls. LV longitudinal strain at endocardium in HTN with LVH decreased, whereas LVEF was similar to that in controls and, which was associated with increased torsion at epicardium. Reduced LVEF in hypertensive HF was associated with reduced strain, SR-S and torsion in all layers and with LV dilation. On multivariate analysis, epicardial torsion was an independent determinant of LVEF. At epicardial torsion cut-off 0.41, the sensitivity and specificity for the identification of HFrEF were 88% and 68%. Torsion on 3D-STE may represent a compensatory mechanism to maintain LVEF despite reduced endocardial function, suggesting that the deterioration of torsion caused by insult to outer muscle and dilation may lead to HFrEF.
内层和外层斜肌收缩引起的左心室（LV）扭转有助于提高射血分数（EF）。外层肌肉在扭转过程中起主要作用。我们使用三维斑点追踪超声心动图（3D-STE）评估高血压（HTN）导致的左心室重构对扭转的影响。在53名对照组和186名高血压患者中，通过3D-STE评估左心室应变、收缩期应变率（SR-S）以及心内膜、心肌中层和心外膜处的扭转情况。扭转定义为心尖与心底旋转角度之差除以长轴长度。无左心室肥厚（LVH）的高血压患者的LVEF以及所有三层的应变、SR-S和扭转情况与对照组相似。有LVH的高血压患者的心内膜处左心室纵向应变降低，而LVEF与对照组相似，且这与心外膜处扭转增加有关。高血压性心力衰竭患者中LVEF降低与所有层的应变、SR-S和扭转降低以及左心室扩张有关。多因素分析显示，心外膜扭转是LVEF的独立决定因素。在心外膜扭转临界值为0.41时，识别射血分数降低的心力衰竭（HFrEF）的敏感度和特异度分别为88%和68%。3D-STE上的扭转可能代表一种尽管心内膜功能降低但仍维持LVEF的代偿机制，这表明外层肌肉损伤和扩张导致的扭转恶化可能会引发HFrEF。
