Ferreira Joana, Marta Liliana, Presume João, Freitas Pedro, Guerreiro Sara, Abecasis João, Reis Carla, Ribeiras Regina, Mendes Miguel, Andrade Maria João
Department of Cardiology, Hospital de São Bernardo, Centro Hospitalar de Setúbal, Setúbal, Portugal.
Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal.
J Cardiovasc Imaging. 2024 Sep 5;32(1):29. doi: 10.1186/s44348-024-00028-z.
Aortic regurgitation (AR) has an important impact on myocardial mechanics and recent studies have proved the value of global longitudinal strain (GLS) in the assessment of its severity and prognosis. Our purpose was to assess if the direct impact of the regurgitant jet on the myocardial wall could affect regional longitudinal strain.
Eighty patients with chronic moderate/severe AR were retrospectively studied. Patients were considered to have a jet-related longitudinal strain reduction when the myocardial segments directly impacted by the jet had their longitudinal strain reduced by at least 30% compared to nonaffected segments. AR severity, left ventricular (LV) size and function were compared according to the presence/absence of this regional pattern. For those who underwent surgery, postoperative regional and global LV function was also analyzed.
A pattern of regional longitudinal strain impairment was identified in 43% of patients, with a regional reduction (in median) of 10 percentage points in absolute strain values in the segments impacted by the jet, compared to nonaffected segments. In the subgroup who underwent surgery, this pattern became attenuated after surgery. Patients with regional longitudinal strain impairment were less likely to improve GLS after surgery (10% vs. 38% improved GLS by at least 2.5%, P = 0.049).
To our knowledge, this study identifies for the first time, a link between the location of the impact of the regurgitant jet in AR and regional longitudinal strain impairment. The presence of this regional pattern might be associated with worse postoperative LV recovery.
主动脉瓣反流（AR）对心肌力学有重要影响，近期研究已证实整体纵向应变（GLS）在评估其严重程度和预后方面的价值。我们的目的是评估反流束对心肌壁的直接影响是否会影响局部纵向应变。
对80例慢性中重度AR患者进行回顾性研究。当受反流束直接影响的心肌节段的纵向应变与未受影响节段相比降低至少30%时，患者被认为存在与反流束相关的纵向应变降低。根据这种局部模式的有无比较AR严重程度、左心室（LV）大小和功能。对于接受手术的患者，还分析了术后局部和整体LV功能。
43%的患者发现存在局部纵向应变受损模式，与未受影响节段相比，受反流束影响节段的绝对应变值（中位数）局部降低了10个百分点。在接受手术的亚组中，这种模式在术后减弱。存在局部纵向应变受损的患者术后GLS改善的可能性较小（GLS改善至少2.5%的患者分别为10%和38%，P = 0.049）。
据我们所知，本研究首次确定了AR中反流束撞击位置与局部纵向应变受损之间的联系。这种局部模式的存在可能与术后LV恢复较差有关。
