Left Ventricular Function in Hypertension: New Insight by Speckle Tracking Echocardiography
Left Ventricular Function in Hypertension: New Insight by Speckle Tracking Echocardiography
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DOI：
10.1111/j.1540-8175.2011.01410.x
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发表时间：
2011-07-01
影响因子：
1.5
通讯作者：
Saitta, Antonino
中科院分区：
文献类型：
--
作者：
Imbalzano, Egidio;Zito, Concetta;Saitta, Antonino
背景：传统的经胸超声心动图（TTE）和组织多普勒成像（TDI）通常无法在出现肥厚（LVH）之前发现由高血压引起的左心室（LV）收缩功能的早期细微异常。本研究旨在评估斑点追踪超声心动图 (STE) 是否可以更深入地了解早期高血压引起的左心室收缩功能障碍，目的是识别心力衰竭 (HF) 风险较高的患者。方法：纳入 51 名患者（56.5 +/- 14 岁）和 51 名对照者（52 +/- 12.6 岁）。根据是否存在 LVH，将患者分别分为 LVH(+) 和 LVH(-)。通过 TDI 计算整体纵向功能，通过 STE 评估整体应变 [纵向 (LS)、径向 (RS) 和周向 (CS)] 和扭曲。结果：常规 TTE 显示所有患者左室舒张功能障碍，收缩功能正常。 TDI 仅能够在 LVH(+) 组中检测到收缩功能障碍（P < 0.001），而 STE 则显示所有患者的收缩功能障碍，包括那些没有肥厚的患者（P = 0.02）。此外，在 LVH(+) 组中，STE 显示 RS 降低，CS 和扭曲增加。在对照组（RS：P = 0.02；CS：P = 0.05；扭曲：P < 0.001）和 LVH（-）患者（RS：P = 0.01；CS：P = 0.003；扭曲：P = 0.001）中观察到了这些最后的改变。结论：在高血压患者中，STE 比传统超声心动图和 TDI 提供了更详细的信息，因为它在肥厚发生之前揭示了收缩功能障碍（心力衰竭的 ACC/AHA 分类 A 期），并确定了一些早期 LV 机械变化，可能会改善这些患者的临床管理。 （超声心动图2011；28：649-657）
Background: Conventional transthoracic echocardiography (TTE) and tissue Doppler imaging (TDI) are usually unable to reveal very early subtle abnormalities in left ventricular (LV) systolic function caused by hypertension, prior to manifestation of hypertrophy (LVH). This study was undertaken to assess whether speckle tracking echocardiography (STE) provides more insight into early hypertension-induced LV systolic dysfunction, with the purpose of identifying patients at higher risk for heart failure (HF). Methods: Fifty-one patients (56.5 +/- 14 years) and 51 controls (52 +/- 12.6 years) were enrolled. According to the presence or absence of LVH, patients were classified as LVH(+) and LVH(-), respectively. Global longitudinal function was calculated by TDI, global strains [longitudinal (LS), radial (RS), and circumferential (CS)] and twist were assessed by STE. Results: Conventional TTE showed a LV diastolic dysfunction with normal systolic function in all patients. TDI was able to detect a systolic dysfunction only in the LVH(+) group (P < 0.001) whereas STE revealed an impairment of systolic LS in all patients, including those without hypertrophy (P = 0.02). Furthermore, in the LVH(+) group, STE showed reduced RS and increased CS and twist. These last alterations were observed with respect to both controls (RS: P = 0.02; CS: P = 0.05; twist: P < 0.001) and LVH(-) patients (RS: P = 0.01; CS: P = 0.003; twist: P = 0.001). Conclusion: In hypertensive patients, STE provides more detailed information than conventional echocardiography and TDI, since it reveals a systolic dysfunction before hypertrophy occurs (Stage A of ACC/AHA classification of HF) and identifies some early LV mechanic changes that might improve the clinical management of these patients. (Echocardiography 2011;28:649-657)