Myocardial strain imaging: how useful is it in clinical decision making?
Myocardial strain imaging: how useful is it in clinical decision making?
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DOI：
10.1093/eurheartj/ehv529
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发表时间：
2016-04-14
影响因子：
39.3
通讯作者：
Urheim S
中科院分区：
文献类型：
--
作者：
Smiseth OA;Torp H;Opdahl A;Haugaa KH;Urheim S
心肌应变是量化左心室（LV）功能的一个原则，现在斑点追踪超声心动图是可行的。最佳评价的应变参数是全局纵向应变（GLS），其作为收缩功能的量度比左心室射血分数（LVEF）更敏感，并且可用于识别心肌病中的亚临床LV功能障碍。此外，建议将GLS作为接受化疗的患者的常规测量，以在LVEF下降之前检测LV功能降低。已提出心肌应变峰值时间的节段间变异性作为室性心律失常风险的预测因子。应变成像可用于指导接受心脏起搏治疗的患者放置LV起搏电极导线。应变也可用于诊断心肌缺血，但该技术还没有充分标准化，不能推荐作为用于此目的的通用工具。左房收缩期峰值应变是评价左室充盈压的一个很有前途的补充指标。应变成像方法仍在开发中，需要进一步的临床试验来确定基于应变成像的临床决策是否会产生更好的结果。考虑到这一重要的限制，应变可以作为一种补充诊断方法应用于临床。
Myocardial strain is a principle for quantification of left ventricular (LV) function which is now feasible with speckle-tracking echocardiography. The best evaluated strain parameter is global longitudinal strain (GLS) which is more sensitive than left ventricular ejection fraction (LVEF) as a measure of systolic function, and may be used to identify sub-clinical LV dysfunction in cardiomyopathies. Furthermore, GLS is recommended as routine measurement in patients undergoing chemotherapy to detect reduction in LV function prior to fall in LVEF. Intersegmental variability in timing of peak myocardial strain has been proposed as predictor of risk of ventricular arrhythmias. Strain imaging may be applied to guide placement of the LV pacing lead in patients receiving cardiac resynchronization therapy. Strain may also be used to diagnose myocardial ischaemia, but the technology is not sufficiently standardized to be recommended as a general tool for this purpose. Peak systolic left atrial strain is a promising supplementary index of LV filling pressure. The strain imaging methodology is still undergoing development, and further clinical trials are needed to determine if clinical decisions based on strain imaging result in better outcome. With this important limitation in mind, strain may be applied clinically as a supplementary diagnostic method.