Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Royal Perth Hospital, Perth, Australia.
J Am Soc Echocardiogr. 2022 Jul;35(7):703-711.e3. doi: 10.1016/j.echo.2022.01.008. Epub 2022 Jan 26.
Left ventricular (LV) global longitudinal strain (GLS) has been proposed as a sensitive marker of myocardial damage in patients with chronic severe aortic regurgitation (AR) and preserved LV ejection fraction (LVEF). However, LV GLS does not take into account the afterload. Noninvasive LV myocardial work is a novel parameter of LV myocardial performance, which integrates measurements of myocardial deformation and noninvasive blood pressure (afterload). The aims of this study were (1) to assess noninvasive LV myocardial work in patients with chronic AR and preserved LVEF and its correlation with other echocardiographic parameters, (2) to evaluate changes of LV myocardial work after aortic valve replacement or repair (AVR), and (3) to assess the relationship between LV myocardial work and postoperative LV reverse remodeling.
Fifty-seven patients (53 ± 16 years; 67% men) with moderate or severe chronic AR and preserved LVEF treated by AVR were included. Noninvasive LV myocardial work indices were measured at baseline and postoperatively (between 2 and 12 months after surgery) and compared with previously reported normal reference ranges.
Based on normal reference values, patients with chronic AR and preserved LVEF had preserved or increased values of LV global work index (GWI; 82% and 18%, respectively) and LV global constructive work (GCW; 74% and 25%, respectively) and preserved LV global work efficiency (GWE). Left ventricular GWI and GCW showed a positive correlation with markers of AR severity and parameters of LV systolic function. Left ventricular GWI, GCW, and GWE decreased after AVR (P < .001), without changes in LV global wasted work (P = .28). The postoperative impairment of LV GWI, observed in 28% of patients, was closely associated with reduced LV reverse remodeling.
Noninvasive myocardial work may allow better understanding of myocardial function and energetics than afterload-dependent echocardiographic parameters in chronic AR with preserved LVEF.
左心室（LV）整体纵向应变（GLS）已被提出作为慢性严重主动脉瓣反流（AR）和保留左心室射血分数（LVEF）患者心肌损伤的敏感标志物。然而，LV GLS 并未考虑到后负荷。无创性左心室心肌做功是一种新的左心室心肌性能参数，它综合了心肌变形和无创血压（后负荷）的测量。本研究的目的是：（1）评估慢性 AR 和保留 LVEF 患者的无创性 LV 心肌做功及其与其他超声心动图参数的相关性；（2）评估主动脉瓣置换或修复（AVR）后 LV 心肌做功的变化；（3）评估 LV 心肌做功与术后 LV 逆重构的关系。
57 例（53±16 岁；67%为男性）慢性 AR 合并中度或重度保留 LVEF 的患者接受 AVR 治疗。在基线和术后（手术 2 至 12 个月后）测量无创性 LV 心肌做功指数，并与之前报道的正常参考范围进行比较。
根据正常参考值，慢性 AR 和保留 LVEF 的患者的 LV 整体做功指数（GWI；分别为 82%和 18%）和 LV 整体做功（GCW；分别为 74%和 25%）保留或增加，LV 整体做功效率（GWE）保持不变。LV GWI 和 GCW 与 AR 严重程度的标志物和 LV 收缩功能参数呈正相关。AVR 后 LV GWI、GCW 和 GWE 降低（P<0.001），LV 整体无效功无变化（P=0.28）。28%的患者术后 LV GWI 受损与 LV 逆重构减少密切相关。
与依赖后负荷的超声心动图参数相比，无创性心肌做功可能更能理解慢性 AR 合并保留 LVEF 患者的心肌功能和能量代谢。
