Contrast echocardiography for assessing left ventricular vortex strength in heart failure: a prospective cohort study
Contrast echocardiography for assessing left ventricular vortex strength in heart failure: a prospective cohort study
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DOI：
10.1093/ehjci/jet049
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发表时间：
2013-11-01
影响因子：
6.2
通讯作者：
Sengupta, Partho P.
中科院分区：
文献类型：
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作者：
Abe, Haruhiko;Caracciolo, Giuseppe;Sengupta, Partho P.
为探讨超声心动图-对比粒子图像速度场仪（Echo-PIV）在心力衰竭（HF）患者中的应用价值，对42例HF患者（23例HF患者和19例对照者）进行了Echo-PIV检测。VS被测量为流体动力学参数，其整合了给定区域上的血流旋转，并与LV机械性能的非侵入性衍生指数相关。与早期和晚期射血分数相比，对照组和射血分数保留的HF患者在等容收缩（IC）期间的VS较高（分别为P 0.002和P 0.01），但射血分数降低的HF患者则不然（P 0.41）。在多变量回归分析中，IC期间的VS（VSIC）与舒张晚期VS和LV纵向应变独立相关（分别为R-2 0.63，P 0.001和P 0.003）。IC期间舒张期VS增加的患者显示出较高的LV每搏输出量（P 0.01）、每搏作功（P 0.02）和机械效率（P 0.008）。中位随访期为2.9年，8（34）例HF患者因失代偿性HF住院。与其他患者相比，这8例患者的纵向应变显著降低（P 0.002），VS变化较低（P 0.004）。我们的初步数据表明，从晚期二尖瓣到IC的涡旋持续存在是二尖瓣和收缩期之间耦合的血流动力学指标。VS的变化与LV机械性能相关，并显示与HF患者中观察到的不良临床结局相关。
This study investigated the incremental role of echocardiographic-contrast particle image velocimetry (Echo-PIV) in patients with heart failure (HF) for measuring changes in left ventricular (LV) vortex strength (VS) during phases of a cardiac cycle.Echo-PIV was performed in 42 patients, including 23 HF patients and 19 controls. VS was measured as a fluid-dynamic parameter that integrates blood flow rotation over a given area and correlated with non-invasively derived indices of LV mechanical performance. In comparison with early and late diastole, the VS was higher during isovolumic contraction (IC) for control and HF patients with the preserved ejection fraction (P 0.002 and P 0.01, respectively), but not for HF patients with the reduced ejection fraction (P 0.41). On multivariable regression analysis, the VS during IC (VSIC) was independently related to late-diastolic VS and LV longitudinal strain (R-2 0.63, P 0.001 and P 0.003, respectively). Patients in whom diastolic VS was augmented during IC showed a higher LV stroke volume (P 0.01), stroke work (P 0.02), and mechanical efficiency (P 0.008). Over a median follow-up period of 2.9 years, eight (34) HF patients were hospitalized for decompensated HF. In comparison with the rest, these eight patients showed markedly reduced longitudinal strain (P 0.002), and lower change in VS (P 0.004).Our preliminary data suggest that the persistence of vortex from late diastole into IC is a haemodynamic measure of coupling between diastole and systole. The change in VS is correlated with LV mechanical performance and shows association with adverse clinical outcomes seen in HF patients.