Left Ventricular Torsion Shear Angle Volume Approach for Noninvasive Evaluation of Diastolic Dysfunction in Preserved Ejection Fraction.
Left Ventricular Torsion Shear Angle Volume Approach for Noninvasive Evaluation of Diastolic Dysfunction in Preserved Ejection Fraction.
复制标题
左心室扭转角体积方法用于在保留的射血分数中无创评估舒张功能障碍。
DOI：
10.1161/jaha.117.007039
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发表时间：
2017-12-29
影响因子：
5.4
通讯作者：
Gupta H
中科院分区：
文献类型：
--
作者：
Sharifov OF;Schiros CG;Aban I;Perry GJ;Dell'italia LJ;Lloyd SG;Denney TS Jr;Gupta H
准确的无创性诊断工具，以评估左心室（LV）舒张功能障碍（LVDD）是有限的保留LV射血分数。我们之前提出了左心室扭转剪切角（φ′）的标准化变化率与左心室容积（V′）在舒张早期的相应变化率之间的关系（表示为−dφ′/dV′），作为左心室舒张功能的测量。我们前瞻性评价了−dφ′/dV′对有创性LV参数的诊断准确性。研究对象（n=36，年龄61±7岁）为LV射血分数≥50%且无急性心肌梗死的受试者，他们接受了冠状动脉造影以评估胸痛和/或呼吸困难。进行了高保真有创LV压力测量和心脏磁共振成像与组织标记。τ，LV舒张期舒张的时间常数，为58±10毫秒（平均值±SD），LV舒张末期压为14.5±5.5 mm Hg。心脏磁共振成像衍生的−dφ′/dV′为5.6±3.7。−dφ′/dV′值与τ和左室舒张末压均相关（r分别为0.39和0.36，P<0.05）。LVDD定义为τ>48毫秒且LV舒张末期压>12 mm Hg（LVDD 1），或者τ>48毫秒且LV舒张末期压>16 mm Hg（LVDD 2）。鉴别LVDD 1的−dφ′/dV′的曲线下面积（AUC）为0.83（0.67 - 0.98，P=0.001），−dφ′/dV′ ≥6.2的灵敏度/特异性为72%/100%。鉴别LVDD_2的−dφ′/dV′ AUC为0.82（0.64 - 1.00，P=0.006），−dφ ′/dV′ ≥6.9的灵敏度/特异性为76%/85%。硝酸甘油给药前和给药后−dφ′/dV′之间存在良好的一致性限度。从左心室扭转容积环获得的−dφ′/dV′是评估左心室射血分数保留的整体LVDD的一个有前景的参数，需要进一步评价。
Accurate noninvasive diagnostic tools for evaluating left ventricular (LV) diastolic dysfunction (LVDD) are limited in preserved LV ejection fraction. We previously proposed the relationship of normalized rate of change in LV torsion shear angle (φ′) to corresponding rate of change in LV volume (V′) during early diastole (represented as −dφ′/dV′) as a measure of LV diastolic function. We prospectively evaluated diagnostic accuracy of −dφ′/dV′ in respect to invasive LV parameters. Participants (n=36, age 61±7 years) with LV ejection fraction ≥50% and no acute myocardial infarction undergoing coronary angiography for chest pain and/or dyspnea evaluation were studied. High‐fidelity invasive LV pressure measurements and cardiac magnetic resonance imaging with tissue tagging were performed. τ, the time constant of LV diastolic relaxation, was 58±10 milliseconds (mean±SD), and LV end‐diastolic pressure was 14.5±5.5 mm Hg. Cardiac magnetic resonance imaging‐derived −dφ′/dV′ was 5.6±3.7. The value of −dφ′/dV′ correlated with both τ and LV end‐diastolic pressure (r=0.39 and 0.36, respectively, P<0.05). LVDD was defined as τ>48 milliseconds and LV end‐diastolic pressure >12 mm Hg (LVDD1), or, alternatively, τ>48 milliseconds and LV end‐diastolic pressure >16 mm Hg (LVDD2). Area under the curve (AUC) of −dφ′/dV′ for identifying LVDD1 was 0.83 (0.67‐0.98, P=0.001), with sensitivity/specificity of 72%/100% for −dφ′/dV′ ≥6.2. AUC of −dφ′/dV′ for identifying LVDD_2 was 0.82 (0.64‐1.00, P=0.006), with sensitivity/specificity of 76%/85% for −dφ′/dV′ ≥6.9. There were good limits of agreement between pre‐ and post‐nitroglycerin −dφ′/dV′. The −dφ′/dV′ obtained from the LV torsion volume loop is a promising parameter for assessing global LVDD with preserved LV ejection fraction and requires further evaluation.