Comparison of Multidirectional Myocardial Deformation Result From Pressure and Volume Overload in Compensatory Stage
Comparison of Multidirectional Myocardial Deformation Result From Pressure and Volume Overload in Compensatory Stage
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代偿期压力和容量超负荷引起的多向心肌变形比较
DOI：
10.1109/access.2018.2882438
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发表时间：
2018
期刊：
影响因子：
3.9
通讯作者：
Li Zhang
中科院分区：
文献类型：
--
作者：
Qingyu Zeng;Lei Wang;Yali Yang;Shuangshuang Kong;Yuman Li;Mingxing Xie;Li Zhang
主动脉瓣狭窄(AS)和主动脉瓣返流(AR)是两种不同血流动力学特征的主动脉瓣畸形。最终，慢性压力和容量超载会导致不同的几何和功能模式。本研究的目的是用三维斑点追踪超声心动图(3D-STE)比较两种不同负荷条件对无症状患者代偿期射血分数正常时心肌变形的影响。在重症主动脉瓣病变中，AR患者36例，AS患者32例。所有受试者均接受常规二维超声心动图和3D-STE检查。比较两组患者的临床和超声心动图特征。与对照组相比，AS组左心室扭转增加，纵向应变、径向应变和周向应变减小。AR患者的特点是心室呈球形扩张，心肌纵向和径向应变降低，并保留旋转运动。单因素线性回归分析显示，AR组年龄、舒张压、E‘、球形指数、舒张末容量指数、每搏量指数、射血分数、左心室重量指数与整体纵向应变(GLS)独立相关，AS组相对室壁厚度、每搏量指数(SVI)、左心室重量指数、峰值速度与GLS独立相关。多元逐步回归分析显示，AR组球形指数、SVI和左心室射血分数(LVEF)与GLS独立相关。在AS组，LVEF、峰值速度、左房内径与GLS独立相关。AS患者的受累心肌层较AR患者严重，但增加扭转是维持有效每搏输出量的代偿机制。多向心肌损伤提醒临床医生，这些患者需要更密切的关注。
Aortic stenosis (AS) and aortic regurgitation (AR) were two types of aortic valve defects which had different hemodynamic characteristics. Ultimately, chronic pressure and volume overloads result in different geometrical and functional patterns. The expectation of our study was to compare the impacts of two different types of loading conditions on myocardial deformation in asymptomatic patients with normal ejection fraction in compensatory stage using three-dimensional speckle tracking echocardiography (3D-STE). Among severe aortic valve disease, 36 patients with AR, and 32 patients with AS were enrolled. All subjects underwent conventional two-dimensional echocardiography and 3D-STE. Clinical and echocardiography characteristics were compared between the groups. Compared with control group, left ventricular twist was increased, along with decreased longitudinal, radial, and circumferential strain in the AS group. And AR patients were characterized by a spherical expansion of ventricle, and reduced myocardial longitudinal and radial strain, along with a preserved rotational motion. In univariate linear regression analysis, age, diastolic blood pressure, e’, sphericity index, end-diastolic volume index, stoke volume index, ejection fraction, and left ventricular mass index were independently associated with global longitudinal strain (GLS) in the AR group and relative wall thickness, stroke volume index (SVI), LV mass index, and peak velocity were independently associated with GLS in the AS group. In addition, multiple stepwise regression analysis showed that sphericity index, SVI, and left ventricular ejection fraction (LVEF) were independently associated with GLS in the AR group. And LVEF, peak velocity, and left atrial dimension were independently associated with GLS in the AS group. The affected myocardial layers of AS patients were worse than AR patients, but increased twist was the compensatory mechanism to maintain the effective stroke volume. Multidirectional myocardial damages alert clinicians to be aware that these patients need closer attention.
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影响因子：
2.8
作者：
Hoffmann, Rainer;Altiok, Ertunc;Frick, Michael
通讯作者：
Frick, Michael
影响因子：
6.2
作者：
Lang, Roberto M.;Badano, Luigi P.;Voigt, Jens-Uwe
通讯作者：
Voigt, Jens-Uwe
影响因子：
2.8
作者：
BUCKBERG, G;EBER, L;GORLIN, R
通讯作者：
GORLIN, R
影响因子：
2.4
作者：
Kerckhoffs RC;Omens J;McCulloch AD
通讯作者：
McCulloch AD
影响因子：
2.4
作者：
Roy C. P. Kerckhoffs;J. Omens;A. McCulloch
通讯作者：
Roy C. P. Kerckhoffs;J. Omens;A. McCulloch