Assessment of left ventricular twist mechanics by speckle tracking echocardiography reveals association between LV twist and myocardial fibrosis in patients with hypertrophic cardiomyopathy
Assessment of left ventricular twist mechanics by speckle tracking echocardiography reveals association between LV twist and myocardial fibrosis in patients with hypertrophic cardiomyopathy
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DOI：
10.1007/s10554-014-0509-6
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发表时间：
2014-12-01
影响因子：
2.1
通讯作者：
Lin, Qiong-Wen
中科院分区：
文献类型：
--
作者：
Zhang, Hong-Ju;Wang, Hao;Lin, Qiong-Wen
本研究旨在探讨左室扭转分析能否检测肥厚型心肌病（HCM）患者心肌纤维化程度。这项前瞻性病例对照研究招募了2012年1月至2013年4月期间检查的81例连续HCM患者。排除5例超声心动图图像质量差的患者后，分析76例患者的数据。健康志愿者（n = 46）作为对照。两组均接受了全面的超声心动图检查（即，Bas-Rotation、AP-Rotation、LVEF、LAD、IVST、LAVi、E/Em、LVMI、通过斑点追踪超声心动图进行的高级LV-扭转分析）和磁共振成像。采用独立样本t检验分析组间差异，Logistic回归分析影响因素。HCM组与对照组的基线特征无显著性差异（均p > 0.05）。HCM患者的基础旋转、AP旋转、LV扭转、LVEF、LAD、IVST、LAVi、E/Em和LVMI显著高于对照组（均p < 0.0001），LVDd和E/A显著低于对照组（均p < 0.001）。HCM伴纤维化组的Bas-Rotation、AP-Rotation、LV-Twist、LAD、IVST、LAVi、E/Em和LVMI均显著高于无纤维化组（p < 0.001），但其他超声心动图参数无显著差异。年龄、基底节旋转、AP旋转、左室扭转、左前降支、IVST、LAVi、E/A、E/Em和LVMI是影响纤维化的重要因素。AUROC分析显示左室扭转对检测心肌纤维化程度具有较高的区分能力（AUC 0.996，95%CI 0.989-1.004，p < 0.001）。左室扭转力学与心肌纤维化程度相关。通过STE评估LV扭转可能具有临床意义。
We aimed to investigate whether left ventricular (LV) twist analysis can detect the extent of myocardial fibrosis in patients with hypertrophic cardiomyopathy (HCM). This prospective case-control study recruited 81 consecutive patients with HCM examined between January 2012 and April 2013. Data of 76 patients were analyzed after excluding 5 patients whose echocardiographic images were of poor quality. Healthy volunteers (n = 46) served as controls. Both groups underwent comprehensive echocardiographic examination (i.e., Bas-Rotation, AP-Rotation, LVEF, LADs, IVST, LAVi, E/Em, LVMI, advanced LV-twist analysis by speckle tracking echocardiography) and magnetic resonance imaging. Between-group differences were analyzed by independent t test; logistic regression analysis was performed to identify effect factors. No significant differences were found between baseline characteristics of HCM and control groups (all p > 0.05). HCM patients had significantly higher Bas-Rotation, AP-Rotation, LV Twist, LVEF, LADs, IVST, LAVi, E/Em and LVMI than controls (all p < 0.0001) and significantly lower LVDd and E/A (both p < 0.001). Bas-Rotation, AP-Rotation, LV-Twist, LADs, IVST, LAVi, E/Em and LVMI were significantly higher in HCM patients with fibrosis than in those without fibrosis (p < 0.001), but no significant differences in other echocardiographic parameters were found between those with and without fibrosis. Age, Bas-Rotation, AP-Rotation, LV twist, LADs, IVST, LAVi, E/A, E/Em, and LVMI were significant effect factors for fibrosis. AUROC analysis showed that LV twist had high discriminatory power to detect extent of myocardial fibrosis (AUC 0.996, 95 % CI 0.989-1.004, p < 0.001). Left ventricular twist mechanics are associated with the extent of myocardial fibrosis. LV-twist assessment by STE may be clinically useful.