Evaluation of Myocardial Deformation in Patients with Sickle Cell Disease and Preserved Ejection Fraction Using Three-Dimensional Speckle Tracking Echocardiography
Evaluation of Myocardial Deformation in Patients with Sickle Cell Disease and Preserved Ejection Fraction Using Three-Dimensional Speckle Tracking Echocardiography
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DOI：
10.1111/j.1540-8175.2012.01710.x
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发表时间：
2012-09-01
影响因子：
1.5
通讯作者：
Mor-Avi, Victor
中科院分区：
文献类型：
--
作者：
Ahmad, Homaa;Gayat, Etienne;Mor-Avi, Victor
背景：镰状细胞病（SCD）是一种血红蛋白病，每500名非洲裔美国人中就有1人患病。虽然已经确定SCD患者存在左室舒张功能障碍，但目前尚不清楚他们是否存在轻微的左室收缩功能障碍，尽管保留了射血分数（EF）。我们使用三维斑点跟踪超声心动图（3DSTE）来评估SCD患者左室收缩和舒张功能的变化。方法：对56例SCD患者（年龄33 +/- 7岁）和28例正常对照（年龄35 +/- 9岁）进行经胸实时三维图像采集（Philips iE33）。采用原型软件（4DLV Analysis, TomTec）进行3DSTE，获得左室体积和变形时间曲线，计算左室收缩和舒张功能指标。结果：在SCD患者中，3dste衍生的左室充盈参数与正常对照有显著差异，反映了快速和心房充盈量的增加和主动弛缓时间的延长，表现为固定时间充盈体积分数的减少和快速充盈时间的增加。整体左室收缩功能不仅保留，而且与对照组相比有所增加，这反映在整体纵向应变显著增加上。重要的是，两组的扭转角和扭转以及三维应变的径向和周向分量相似。结论：3DSTE能够证实一些SCD患者的舒张功能不全。但3DSTE应变分析未发现左室收缩功能有任何变化。这些发现为SCD心血管并发症的病理生理学提供了新的见解。
Background: Sickle cell disease (SCD) is a hemoglobinopathy that affects one in 500 African Americans. Although it is well established that patients with SCD have left ventricular (LV) diastolic dysfunction, it is not clear whether they have subtle LV systolic dysfunction despite preserved ejection fraction (EF). We used three-dimensional speckle tracking echocardiography (3DSTE) to assess changes in both systolic and diastolic LV function in SCD. Methods: Transthoracic real time 3D images were obtained (Philips iE33) in 56 subjects, including 28 stable outpatients with SCD (age 33 +/- 7 years) and 28 normal controls (age 35 +/- 9 years). 3DSTE was performed using prototype software (4DLV Analysis, TomTec) to obtain LV volume and deformation time curves, from which indices of systolic and diastolic LV function were calculated. Results: In SCD patients, 3DSTE-derived LV filling parameters were significantly different from normal controls, reflecting an increase in both rapid and atrial filling volumes and prolonged active relaxation, depicted by a decrease in filling volume fractions at fixed times and an increase in rapid filling duration. Global LV systolic function was not only preserved but increased compared to controls, as reflected by significantly increased global longitudinal strain. Importantly, twist angle and torsion as well as radial and circumferential components of 3D strain were similar in both groups. Conclusions: 3DSTE was able to confirm diastolic dysfunction, as expected in some patients with SCD. However, 3DSTE strain analysis did not reveal any changes in LV systolic function. These findings provide novel insight into the pathophysiology of the cardiovascular complications of SCD.