通过二维斑点追踪和跑步机负荷超声心动图评估左心房应变（LAS）对E/e'在8至14之间的肥厚型心肌病（HCM）患者运动耐量的预测价值。
Assessment the Predictive Value of Left Atrial Strain (LAS) on Exercise Tolerance in HCM Patients with E/e' between 8 and 14 by Two-Dimensional Speckle Tracking and Treadmill Stress Echocardiography.
作者信息
Su Ye, Li Chunmei, Yin Lixue
机构信息
School of Medicine, University of Electronic Science and Technology of China, 611730 Chengdu, Sichuan, China.
Department of Cardiovascular Ultrasound, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 610031 Chengdu, Sichuan, China.
出版信息
Rev Cardiovasc Med. 2023 Jun 8;24(6):167. doi: 10.31083/j.rcm2406167. eCollection 2023 Jun.
BACKGROUND
The aim of this study was to evaluate the reservoir, conduit, and contraction function of the left atrium and to evaluate the predictive value of left atrial strain (LAS) on exercise tolerance in hypertrophic cardiomyopathy (HCM) patients with an E/e' between 8 and 14 by two-dimensional speckle tracking using treadmill stress echocardiography.
METHODS
This was a retrospective study in which we analyzed a total of 70 patients with HCM between 2016 and 2017. According to the resting state E/e', patients were either assigned to an HCM-1 group (E/e' 14) or an HCM-2 group (E/e' of 8 to 14). Thirty age-matched healthy controls were included in the normal group. Analysis involved the left atrial reservoir, conduit, contraction strain and reserve function.
RESULTS
The normal group had a higher left atrial reservoir and conduit strain than the HCM-2 group; the lowest values were in the HCM-1 group. The LAS reserve capacity of the HCM-1 and HCM-2 groups was lower than those of the normal group. The left atrial contraction strain reserve ( LASct%) and global longitudinal strain reserve ( GLS%) were lower in the HCM-2 and HCM-1 groups than in the normal group. We also found that the LASct% and GLS% in the HCM-2 group were higher than in the HCM-1 group. Furthermore, the metabolic equivalents (METS) in the HCM-2 group was greater than that in the HCM-1 group. Finally, the Rest-LASr indicated the highest differential diagnostic performance for METS 6.0 (area under curve [AUC]: 0.759); the AUC of the composite model Rest-LASr+E/e'-rest was 0.8.
CONCLUSIONS
Analysis showed that when the E/e' was between 8 and 14, the LAS and reserve capacity of HCM patients were significantly reduced. Our findings suggest that the routine assessment of LAS +E/e' can be a strategy with which to supplement current predictive models and facilitate clinical management strategies.
背景
本研究旨在评估肥厚型心肌病（HCM）患者左心房的储存、管道及收缩功能，并通过二维斑点追踪技术结合平板运动负荷超声心动图，评估左心房应变（LAS）对静息状态下E/e'为8至14的HCM患者运动耐量的预测价值。
方法
这是一项回顾性研究，我们分析了2016年至2017年间共70例HCM患者。根据静息状态下的E/e'，患者被分为HCM-1组（E/e'＞14）或HCM-2组（E/e'为8至14）。正常组纳入30例年龄匹配的健康对照。分析包括左心房储存、管道、收缩应变及储备功能。
结果
正常组的左心房储存和管道应变高于HCM-2组；最低值出现在HCM-1组。HCM-1组和HCM-2组的LAS储备能力低于正常组。HCM-2组和HCM-1组的左心房收缩应变储备（ΔLASct%）和整体纵向应变储备（ΔGLS%）低于正常组。我们还发现HCM-2组的ΔLASct%和ΔGLS%高于HCM-1组。此外，HCM-2组的代谢当量（METS）大于HCM-1组。最后，静息状态下的LASr对METS＞6.0具有最高的鉴别诊断性能（曲线下面积[AUC]：0.759）；复合模型静息状态下的LASr + E/e'-静息的AUC为0.8。
结论
分析表明，当E/e'在8至14之间时，HCM患者的LAS及储备能力显著降低。我们的研究结果表明，常规评估LAS + E/e'可作为一种补充当前预测模型并促进临床管理策略的方法。
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