Meyer Tom, Wellge Brunhilde, Barzen Gina, Klemmer Chandia Stefan, Knebel Fabian, Hahn Katrin, Elgeti Thomas, Fischer Thomas, Braun Jürgen, Tzschätzsch Heiko, Sack Ingolf
Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Amyloidosis Center Charité Berlin (ACCB), Charité-Universitätsmedizin Berlin, Berlin, Germany.
J Am Soc Echocardiogr. 2025 May;38(5):431-442. doi: 10.1016/j.echo.2024.11.009. Epub 2024 Dec 6.
Heart failure is an increasing global health problem. Approximately 50% of patients with heart failure have heart failure with preserved ejection fraction (HFpEF) and concomitant diastolic dysfunction (DD), in part caused by increased myocardial stiffness not detectable by standard echocardiography. While elastography can map tissue stiffness, cardiac applications are currently limited, especially in patients with a higher body mass index. Therefore, we developed cardiac time-harmonic elastography (THE) to detect abnormal diastolic myocardial stiffness associated with DD.
Cardiac THE was developed using standard medical ultrasound and continuous external vibration for regionally resolved mapping of diastolic shear wave speed as a proxy for myocardial stiffness. The method was prospectively applied to 54 healthy controls (26 women), 10 patients with moderate left ventricular hypertrophy (mLVH; 5 women), and 45 patients with wild-type transthyretin amyloidosis (wTTR; 4 women), 20 of whom were treated with tafamidis. Ten healthy participants were reinvestigated after 2 to 6 months to analyze test-retest reproducibility by intraclass correlation coefficients.
Myocardial shear wave speed was measured with good reproducibility (intraclass correlation coefficient = 0.82) and showed higher values in wTTR (3.0 ± 0.7 m/sec) than in mLVH (2.1 ± 0.6 m/sec) and healthy controls (1.8 ± 0.3 m/sec, all P < .05). Area under the curve values were 0.991 and 0.737 for discriminating wTTR and mLVH from healthy controls, respectively. Shear wave speed was reduced in patients after tafamidis treatment (2.6 ± 0.6 m/sec, P = .04), suggesting the potential value of THE for therapy monitoring. Shear wave speed was quantified in the septum, posterior wall, and an automatically masked region (here stated for the septal region).
Cardiac THE detects abnormal myocardial stiffness in patients with DD with high penetration depth, independent of body mass index and region selection. Based on standard ultrasound components, cardiac THE is cost-effective and has the potential to become a point-of-care method for stiffness-sensitive echocardiography.
心力衰竭是一个日益严重的全球健康问题。约50%的心力衰竭患者为射血分数保留的心力衰竭（HFpEF）并伴有舒张功能障碍（DD），部分原因是心肌僵硬度增加，而标准超声心动图无法检测到这种增加。虽然弹性成像可以绘制组织僵硬度，但目前心脏应用有限，尤其是在体重指数较高的患者中。因此，我们开发了心脏时间谐波弹性成像（THE）来检测与DD相关的舒张期心肌僵硬度异常。
利用标准医学超声和连续外部振动开发心脏THE，用于区域分辨舒张期剪切波速度映射，以此作为心肌僵硬度的替代指标。该方法前瞻性应用于54名健康对照者（26名女性）、10名中度左心室肥厚患者（mLVH；5名女性）和45名野生型转甲状腺素蛋白淀粉样变性患者（wTTR；4名女性），其中20名接受了tafamidis治疗。10名健康参与者在2至6个月后再次接受检查，通过组内相关系数分析重测再现性。
心肌剪切波速度测量具有良好的再现性（组内相关系数 = 0.82），且wTTR患者（3.0 ± 0.7米/秒）的值高于mLVH患者（2.1 ± 0.6米/秒）和健康对照者（1.8 ± 0.3米/秒，所有P < 0.05）。区分wTTR和mLVH与健康对照者的曲线下面积值分别为0.991和0.737。tafamidis治疗后患者的剪切波速度降低（2.6 ± 0.6米/秒，P = 0.04），表明THE在治疗监测方面的潜在价值。在室间隔、后壁和一个自动标记区域（此处以室间隔区域为例）对剪切波速度进行了量化。
心脏THE可检测DD患者异常的心肌僵硬度，穿透深度高，不受体重指数和区域选择的影响。基于标准超声组件，心脏THE具有成本效益，有潜力成为一种用于僵硬度敏感超声心动图的床旁检查方法。
