Geometry as a Confounder When Assessing Ventricular Systolic Function Comparison Between Ejection Fraction and Strain
Geometry as a Confounder When Assessing Ventricular Systolic Function Comparison Between Ejection Fraction and Strain
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DOI：
10.1016/j.jacc.2017.06.046
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发表时间：
2017-08-22
影响因子：
24
通讯作者：
Remme, Espen W.
中科院分区：
文献类型：
--
作者：
Stokke, Thomas M.;Hasselberg, Nina E.;Remme, Espen W.
背景：在肥厚性心肌病、缺血性心脏病、糖尿病等患者中均有左心室射血分数（EF）保留和心肌应变降低的报道。目的：作者进行了一项综合数学和超声心动图研究，以了解EF和菌株之间的不一致性。方法以椭圆LV模型为基础，建立EF与整体纵向应变（GLS）、整体周向应变（GCS）、壁厚、短轴直径4个参数的关系解析方程。通过超声心动图测量100例EF范围为16% ~ 72%的受试者的4个参数，并将模型预测的EF与实测的EF进行比较，验证了方程的正确性。在模型中探讨了不同参数对EF的影响，并与患者结果进行了比较。结果计算的EF与实测值吻合良好（r = 0.95）。该模型表明，GCS对EF的贡献是GLS的两倍多。GLS的显著降低可以通过GCS或壁厚或直径的微小增加来补偿。该模型进一步证明了脑室壁厚增加或直径减小时EF如何维持，尽管纵向和周向缩短都有所减少。这与20名对照组和20名肥厚性心肌病患者的相似EF一致，壁厚增加，圆周和纵向缩短均减少（均p < 0.01）。结论在保留EF的情况下，变形减少可以通过几何因素来解释。由于几何混杂因素，应变能更好地反映(C)患者的收缩功能。由爱思唯尔代表美国心脏病学会基金会出版。
BACKGROUND Preserved left ventricular (LV) ejection fraction (EF) and reduced myocardial strain are reported in patients with hypertrophic cardiomyopathy, ischemic heart disease, diabetes mellitus, and more.OBJECTIVES The authors performed a combined mathematical and echocardiographic study to understand the inconsistencies between EF and strains.METHODS An analytical equation showing the relationship between EF and the 4 parameters, global longitudinal strain (GLS), global circumferential strain (GCS), wall thickness, and short-axis diameter, was derived from an elliptical LV model. The equation was validated by measuring the 4 parameters by echocardiography in 100 subjects with EF ranging from 16% to 72% and comparing model-predicted EF with measured EF. The effect of the different parameters on EF was explored in the model and compared with findings in the patients.RESULTS Calculated EF had very good agreement with measured EF (r = 0.95). The model showed that GCS contributes more than twice as much to EF than GLS. A significant reduction of GLS could be compensated by a small increase of GCS or wall thickness or reduced diameter. The model further demonstrated how EF can be maintained in ventricles with increased wall thickness or reduced diameter, despite reductions in both longitudinal and circumferential shortening. This was consistent with similar EF in 20 control subjects and 20 hypertrophic cardiomyopathy patients with increased wall thickness and reductions in both circumferential and longitudinal shortening (all p < 0.01).CONCLUSIONS Reduced deformation despite preserved EF can be explained through geometric factors. Due to geometric confounders, strain better reflects systolic function in patients with (C) 2017 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.