Noninvasive assessment of regional and global myocardial contractility in normal control subjects and in patients with dilated cardiomyopathies
Noninvasive assessment of regional and global myocardial contractility in normal control subjects and in patients with dilated cardiomyopathies
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DOI：
10.1111/j.1540-8175.1998.tb00629.x
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发表时间：
1998-07-01
影响因子：
1.5
通讯作者：
Mirsky, I
中科院分区：
文献类型：
--
作者：
Domanski, MJ;Follman, D;Mirsky, I
本研究的目的是开发一种新的非侵入性的方法来评估局部和整体心肌收缩力，而不需要药物干预来改变负荷。研究了34名健康成人和5名扩张型心肌病（DCM）成人。从研究中排除糖尿病和甲状腺功能亢进症患者。其余患者接受超声心动图、血压计血压测定和颈动脉脉搏描记。在胸骨旁长轴四腔心切面和二腔心切面上将左室横截面分为20个节段。收缩末期压和左心室射血时间的相关测量能够确定缩短、缩短率和射血分数/后负荷关系。判别分析表明，DCM患者的射血分数/后负荷关系与对照组有很大不同，在这方面是最敏感的。对照受试者的内皮细胞缩短、中壁缩短和射血分数/后负荷关系呈线性或非线性。因此，本研究允许在不需要药物干预的情况下评估个体受试者的收缩力，因为负荷改变源于左心室中从基部到心尖的壁应力的变化。更重要的是，该方法可以应用于节段性收缩功能异常的患者。
The aim of the present study was to develop a new noninvasive approach for the assessment of regional and global myocardial contractility without the need for pharmacological intervention to alter load. Thirty-four healthy adults and five adults with dilated cardiomyopathy (DCM) were studied. Patients with diabetes mellitus and hyperthyroidism were eliminated from the study. The remainder underwent echocardiography, sphygmomanometric blood pressure determination, and carotid pulse tracings. Left ventricular cross section in the parasternal long-axis four- and two-chamber views was divided into 20 segments. Associated measurements of end-systolic pressure and left ventricular ejection time enabled shortening, shortening rate, and ejection fraction/afterload relationships to be determined. A discriminant analysis showed that the ejection fraction/afterload relationship in patients with DCM differed substantially from that of control subjects and was the most sensitive in this regard. Endocardial shortening, mid-wall shortening, and ejection fraction/afterload relationships demonstrated linearity or nonlinearity for control subjects. This study thus permits the assessment of contractility in individual subjects without the need for drug interventions because load alteration stems from the variation of wall stress from base to apex in, the left ventricle. More importantly, the approach may be applied to patients with segmental abnormalities of contractile function.