在扩张型心肌病患者中，心肺运动试验期间的运动峰值心肌变形指数与运动能力和通气效率相关。
Peak exercise myocardial deformation indices during cardiopulmonary exercise testing are associated with exercise capacity and ventilatory efficiency in patients with dilated cardiomyopathy.
作者信息
Triantafyllidi Helen, Birmpa Dionyssia, Ikonomidis Ignatios, Benas Dimitrios, Makavos George, Cokkinos Dennis V, Triposkiadis Filippos, Iliodromitis Efstathios K
机构信息
2(nd) Department of Cardiology, Medical School, National and Kapodistrian University of Athens, ATTIKON Hospital, Athens, Greece.
2(nd) Department of Cardiology, Medical School, National and Kapodistrian University of Athens, ATTIKON Hospital, Athens, Greece.
出版信息
Hellenic J Cardiol. 2023 Mar-Apr;70:28-35. doi: 10.1016/j.hjc.2022.12.009. Epub 2022 Dec 28.
OBJECTIVE
Little is known about the exercise-induced changes in the multidimensional mechanical properties of the heart. We aimed to evaluate the myocardial deformation indices (MDI) at rest and their response at peak exercise during the same cardiopulmonary exercise testing (CPET) session, investigating their relationship to exercise capacity and ventilatory sufficiency in dilated cardiomyopathy (DCM) patients.
METHODS
We evaluated left ventricular (LV) function using speckle tracking imaging (STI) at rest and peak exercise during the same CPET session in 57 idiopathic DCM patients in New York Heart Association (NYHA) I-II class [54 ± 12 years, 42 males, ejection fraction (EF) 33 ± 9%]. We measured global longitudinal strain (GLS), longitudinal strain rate at systole (LSRS) and diastole (LSRD), and circumferential strain rate (CircS).
RESULTS
Resting GLS, LSRS, and LSRD were impaired compared with the predicted values but were improved at peak exercise (p < 0.001). All MDI at rest and/or at peak exercise were related to several CPET-derived parameters, including peak VO, load, O pulse, and VE/VCO slope. Peak exercise LSRS > -1.10 sec (AUC = 0.80, p < 0.001) and GLS > -13% (AUC = 0.81, p = 0.002) predicted impaired exercise capacity (peak VO < 20 ml/min/kg) and ventilatory inefficiency (VE/VCO slope>34). In multiple regression analysis, peak exercise LSRS and GLS were independently related to the peak VO (Beta = -0.39, p = 0.003) and VE/VCO slope (Beta = 0.35, p = 0.02), respectively.
CONCLUSIONS
Peak exercise LSRS and GLS in NYHA I-II DCM patients subjected to CPET were associated with aerobic exercise capacity and ventilatory efficiency. Consequently, LSRS and GLS at peak exercise, through their association with CPET-derived CV risk indices, may underline the severity of heart failure and predict future CV events in this DCM population.
目的
关于运动引起的心脏多维力学特性变化，我们知之甚少。我们旨在评估在同一次心肺运动试验（CPET）过程中静息状态下的心肌变形指数（MDI）及其在运动峰值时的反应，研究它们与扩张型心肌病（DCM）患者运动能力和通气充足性的关系。
方法
我们在同一次CPET过程中，对57例纽约心脏协会（NYHA）I-II级的特发性DCM患者[年龄54±12岁，男性42例，射血分数（EF）33±9%]，使用斑点追踪成像（STI）评估静息和运动峰值时的左心室（LV）功能。我们测量了整体纵向应变（GLS）、收缩期纵向应变率（LSRS）和舒张期纵向应变率（LSRD）以及圆周应变率（CircS）。
结果
与预测值相比，静息时的GLS、LSRS和LSRD受损，但在运动峰值时有所改善（p<0.001）。静息和/或运动峰值时的所有MDI均与几个CPET衍生参数相关，包括峰值VO₂、负荷、脉搏血氧饱和度和VE/VCO₂斜率。运动峰值时LSRS>-1.10秒（AUC=0.80，p<0.001）和GLS>-13%（AUC=0.81，p=0.002）可预测运动能力受损（峰值VO₂<20ml/min/kg）和通气效率低下（VE/VCO₂斜率>34）。在多元回归分析中，运动峰值时的LSRS和GLS分别独立与峰值VO₂（β=-0.39，p=0.003）和VE/VCO₂斜率（β=0.35，p=0.02）相关。
结论
接受CPET检查的NYHA I-II级DCM患者运动峰值时的LSRS和GLS与有氧运动能力和通气效率相关。因此，运动峰值时的LSRS和GLS，通过它们与CPET衍生的心血管风险指数的关联，可能突显该DCM人群心力衰竭的严重程度并预测未来心血管事件。
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