Left Ventricular Function in Patients with Pulmonary Arterial Hypertension: The Role of Two-Dimensional Speckle Tracking Strain
Left Ventricular Function in Patients with Pulmonary Arterial Hypertension: The Role of Two-Dimensional Speckle Tracking Strain
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DOI：
10.1111/echo.13267
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发表时间：
2016-09-01
影响因子：
1.5
通讯作者：
Pereira Nunes, Maria Carmo
中科院分区：
文献类型：
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作者：
Correa, Ricardo de Amorim;de Oliveira, Fernanda Brito;Pereira Nunes, Maria Carmo
背景：肺动脉高压（PAH）的特征是平均肺动脉压升高，右心室（RV）压力异常超载，可能改变左心室（LV）功能。本研究的目的是利用二维（2D）斑点跟踪应变来评估左室压力过载对PAH患者左室功能的影响。方法：本研究纳入37例1组PAH患者和38例年龄和性别匹配的健康对照。测量左室纵向和径向二维应变，包括室间隔和不包括室间隔。6分钟步行试验（6MWT）和脑利钠肽（BNP）水平也在PAH患者中得到。结果：患者平均年龄46.4±14.8岁，女性占76%，16例（43%）为血吸虫病。16名患者（43%）在接受PAH特异性治疗时属于WHO III或IV类。6MWT总距离为441米，BNP水平为80 pg/mL。与对照组相比，PAH患者更常表现为左室舒张功能障碍和右室功能损害。患者左室整体纵向和径向应变均低于对照组（-17.9 +/- 2.8 vs -20.5 +/- 1.9, P < 0.001; 30.8 +/- 10.5 vs 49.8 +/- 15.4, P < 0.001）。在排除间隔值后，患者左室纵向和径向应变仍低于对照组。与左室整体纵向应变相关的独立因素是左室射血分数、右室分数面积变化和三尖瓣环收缩运动。结论：本研究显示，与室间隔受累与否无关，通过斑点追踪应变评估PAH患者的左室收缩性受损。调整左室射血分数后，左室整体纵向应变与左室分数面积变化和三尖瓣环收缩运动独立相关。
Background: Pulmonary arterial hypertension (PAH) is characterized by elevated mean pulmonary arterial pressure with abnormal right ventricular (RV) pressure overload that may alter left ventricular (LV) function. The aim of this study was to assess the impact of RV pressure overload on LV function in PAH patients using two-dimensional (2D) speckle tracking strain. Methods: The study enrolled 37 group 1 PAH patients and 38 age-and gender-matched healthy controls. LV longitudinal and radial 2D strains were measured with and without including the ventricular septum. Six-minute walk test (6MWT) and brain natriuretic peptide (BNP) levels were also obtained in patients with PAH. Results: The mean age of patients was 46.4 +/- 14.8 years, 76% women, and 16 patients (43%) had schistosomiasis. Sixteen patients (43%) were in WHO class III or IV under specific treatment for PAH. The overall 6MWT distance was 441 meters, and the BNP levels were 80 pg/mL. Patients with PAH more commonly presented with LV diastolic dysfunction and impairment of RV function when compared to controls. LV global longitudinal and radial strains were lower in patients than in controls (-17.9 +/- 2.8 vs. -20.5 +/- 1.9; P < 0.001 and 30.8 +/- 10.5 vs. 49.8 +/- 15.4; P < 0.001, respectively). After excluding septal values, LV longitudinal and radial strains remained lower in patients than in controls. The independent factors associated with global LV longitudinal strain were LV ejection fraction, RV fractional area change, and tricuspid annular systolic motion. Conclusions: This study showed impaired LV contractility in patients with PAH assessed by speckle tracking strain, irrespective of ventricular septal involvement. Global LV longitudinal strain was associated independently with RV fractional area change and tricuspid annular systolic motion, after adjustment for LV ejection fraction.