Myocardial Deformation Imaging by Two-Dimensional Speckle-Tracking Echocardiography in Comparison to Late Gadolinium Enhancement Cardiac Magnetic Resonance for Analysis of Myocardial Fibrosis in Severe Aortic Stenosis
Myocardial Deformation Imaging by Two-Dimensional Speckle-Tracking Echocardiography in Comparison to Late Gadolinium Enhancement Cardiac Magnetic Resonance for Analysis of Myocardial Fibrosis in Severe Aortic Stenosis
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DOI：
10.1016/j.amjcard.2014.07.018
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发表时间：
2014-10-01
影响因子：
2.8
通讯作者：
Frick, Michael
中科院分区：
文献类型：
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作者：
Hoffmann, Rainer;Altiok, Ertunc;Frick, Michael
斑点跟踪超声心动图(STE)心肌形变分析已被用于心肌存活和心肌纤维化的分析。众所周知，严重的主动脉狭窄患者会发展成心肌纤维化。这项研究评估了严重主动脉狭窄患者的晚期Gd增强(LGE)、心脏磁共振(CMR)和二维STE所确定的心肌纤维化之间的关系。对30例(78+/-7岁)重度主动脉瓣狭窄(平均梯度53+/-21 mm Hg)患者，采用二维超声心动图胸骨旁短轴切面的峰值收缩周向应变和心尖切面的峰值收缩纵向应变进行局部功能分析。超声心动图后24小时内进行LGE-CMR以确定各节段的纤维化量。以LGE CMR为灰阶阈值，以高于正常远隔心肌平均信号强度6个月为标准，确定相对纤维化量。LGE自底向心尖递减(基底段14.4+/-8.7%，室中段3.4+/-3.0%，心尖段2.1+/-3.0%)，以收缩期峰应变值小于-11.6%为标准，敏感性为65%，特异性为75%(受试者工作特征曲线下面积为0.69)。综上所述，在严重的主动脉狭窄患者中，心肌纤维化从左心室心尖节段到基础节段逐渐增加。LGE CMR所定义的心肌纤维化程度与STE所定义的心肌变形之间存在相关性。(C)2014 Elsevier Inc.保留所有权利。
Myocardial deformation analysis by speckle-tracking echocardiography (STE) has been used for analysis of myocardial viability and myocardial fibrosis. Patients with severe aortic stenosis are known to develop myocardial fibrosis. This study evaluated the association between myocardial fibrosis determined by late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) and 2-dimensional STE in patients with severe aortic stenosis. In 30 patients (78 +/- 7 years) with severe aortic stenosis (mean gradient 53 +/- 21 mm Hg), peak systolic circumferential strain based on 2-dimensional echocardiographic parasternal short-axis views and peak systolic longitudinal strain based on apical views were determined for analysis of regional function. LGE CMR was performed to define the amount of fibrosis in each segment within 24 hours of echocardiography. Relative amount of fibrosis was determined based on LGE CMR as gray-scale threshold 6 SDs above the mean signal intensity of the normal remote myocardium. There was a decrease in LGE from base to apex (14.4 +/- 8.7% for basal segments, 3.4 +/- 3.0% for midventricular segments, and 2.1 +/- 3.0% for apical segments; p 10% could be identified by peak systolic longitudinal strain less than -11.6%, with a sensitivity of 65% and a specificity of 75% (area under the receiver operating characteristic curve 0.69). In conclusion, myocardial fibrosis increases from apical to basal left ventricular segments in patients with severe aortic stenosis. There is an association between severity of myocardial fibrosis defined by LGE CMR and myocardial deformation by STE. (C) 2014 Elsevier Inc. All rights reserved.