Left Ventricular Myocardial Function in Children With Pulmonary Hypertension: Relation to Right Ventricular Performance and Hemodynamics.
Left Ventricular Myocardial Function in Children With Pulmonary Hypertension: Relation to Right Ventricular Performance and Hemodynamics.
复制标题
患有肺动脉高压的儿童的左心室心肌功能：与右心室性能和血液动力学的关系。
DOI：
10.1161/circimaging.115.003260
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发表时间：
2015-08
期刊：
影响因子：
--
通讯作者：
Friedberg MK
中科院分区：
文献类型：
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作者：
Burkett DA;Slorach C;Patel SS;Redington AN;Ivy DD;Mertens L;Younoszai AK;Friedberg MK
通过心室相互依赖，肺动脉高压（PH）诱导左心室（LV）功能障碍。我们假设，左心室应变/应变率，心肌收缩力的替代措施，减少在小儿PH和有创血流动力学，右心室（RV）应变，PH的功能措施。在两个机构，超声心动图进行了前瞻性的54例小儿PH患者在心导管插入术，并在54个匹配的对照。PH患者的LV整体纵向应变（LS）降低（-18.8 [-17.3 - -20.4]% vs. -20.2 [-19.0 - -20.9]%，P=0.0046）主要是由于基础剂量降低（-12.9 [-10.8 - -16.3]% vs. -17.9 [-14.5 - -20.7]%，P<0.0001）和中度（-17.5 [-15.5 - -19.0]% vs. -21.1 [-19.1 - -23.0]%，P<0.0001）间隔应变。基底全球周向应变（CS）降低（-18.7 [-15.7 - -22.1]% vs. -20.6 [-19.0 - -22.5]%，P=0.0098），间隔段和自由壁段也是如此。游离壁内CS中段减少。应变率以类似的模式降低。室间隔基底段和中段的LS与PH程度（r=0.66，P<0.0001）、肺血管阻力（r = 0.60，P<0.0001）和RV游离壁LS（r=0.64，P<0.0001）密切相关。脑钠肽水平与间隔LS中度相关（r=0.48，P=0.0038）。PH功能分级与左室游离壁LS中度相关（r=-0.48，P=0.0051）。室间隔，心室之间共享，并受到室间隔移位的影响，是最受影响的左心室区域在PH。儿科PH患者表现出降低的左心室应变/应变率，主要是在隔膜内，与侵入性血流动力学，RV应变，和功能PH的措施。
Through ventricular interdependence, pulmonary hypertension (PH) induces left ventricular (LV) dysfunction. We hypothesized that LV strain/strain rate, surrogate measures of myocardial contractility, are reduced in pediatric PH and relate to invasive hemodynamics, right ventricular (RV) strain, and functional measures of PH. At two institutions, echocardiography was prospectively performed in 54 pediatric PH patients during cardiac catheterization, and in 54 matched controls. PH patients had reduced LV global longitudinal strain (LS) (-18.8 [-17.3 - -20.4]% vs. -20.2 [-19.0 - -20.9]%, P=0.0046) predominantly due to reduced basal (-12.9 [-10.8 - -16.3]% vs. -17.9 [-14.5 - -20.7]%, P<0.0001) and mid (-17.5 [-15.5 - -19.0]% vs. -21.1 [-19.1 - -23.0]%, P<0.0001) septal strain. Basal global circumferential strain (CS) was reduced (-18.7 [-15.7 - -22.1]% vs. -20.6 [-19.0 - -22.5]%, P=0.0098), as were septal and free-wall segments. Mid CS was reduced within the free-wall. Strain rates were reduced in similar patterns. “Basal septum” LS, the combined average LS of basal and mid interventricular septal segments, correlated strongly with degree of PH (r=0.66, P<0.0001), pulmonary vascular resistance (r=0.60, P<0.0001), and RV free-wall LS (r=0.64, P<0.0001). Brain natriuretic peptide levels correlated moderately with septal LS (r=0.48, P=0.0038). PH functional class correlated moderately with LV free-wall LS (r=-0.48, P=0.0051). The septum, shared between ventricles and affected by septal shift, was the most affected LV region in PH. Pediatric PH patients demonstrate reduced LV strain/strain rate, predominantly within the septum, with relationships to invasive hemodynamics, RV strain, and functional PH measures.