Impact of global left ventricular afterload on left ventricular function in asymptomatic severe aortic stenosis: a two-dimensional speckle-tracking study
Impact of global left ventricular afterload on left ventricular function in asymptomatic severe aortic stenosis: a two-dimensional speckle-tracking study
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DOI：
10.1093/ejechocard/jeq014
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发表时间：
2010-07-01
影响因子：
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通讯作者：
Pierard, Luc A.
中科院分区：
文献类型：
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作者：
Lancellotti, Patrizio;Donal, Erwan;Pierard, Luc A.
目的探讨左心室整体后负荷对主动脉瓣狭窄(AS)患者左心室收缩功能的影响。方法与结果应用二维散斑追踪技术对173例无症状的重度AS患者的左心室心肌纵向、径向和周向变形进行了前瞻性检测。38例患者(22%)以低搏出量指数(=5毫米汞毫升/米(2))确定为低流量。多因素分析显示，全身动脉顺应性(P=0.001)、心肌周向变形量(P=0.024)和左房面积指数(P=0.04)与整体LV负荷增加独立相关。结论在无症状的重度AS患者中，LV射血分数明显低估了心肌收缩功能受损的程度。内源性心肌功能障碍在整体LV后负荷增加的患者中尤其常见，尤其是在低流量AS患者中。
Aims The present study sought to assess the effect of global left ventricular (LV) afterload on LV myocardial systolic function in patients with aortic stenosis (AS) and preserved LV ejection fraction.Methods and results We prospectively examined the LV myocardial deformation (i.e. longitudinal, radial, and circumferential) by two-dimensional speckle tracking in 173 patients with asymptomatic severe AS. Thirty-eight patients (22%) had low flow as determined by a low stroke volume index (= 5 mmHg mL/m(2)). Systemic arterial compliance (P = 0.001), circumferential myocardial deformation (P = 0.024), and left atrial area index (P = 0.04) were independently associated with increased global LV load in multivariable analysis. Of note, LV ejection fraction was not identified as a determinant of low flow or increased afterload.Conclusion In asymptomatic patients with severe AS, LV ejection fraction markedly underestimates the extent of myocardial systolic impairment. Intrinsic myocardial dysfunction is particularly common in patients with increased global LV afterload, and especially in the subset of patients with low-flow AS.