Longitudinal Left Ventricular Strain in Hypertrophic Cardiomyopathy: Correlation with Nonsustained Ventricular Tachycardia
Longitudinal Left Ventricular Strain in Hypertrophic Cardiomyopathy: Correlation with Nonsustained Ventricular Tachycardia
复制标题
DOI：
10.1111/j.1540-8175.2011.01427.x
复制
发表时间：
2011-08-01
影响因子：
1.5
通讯作者：
Santos, Oliveira
中科院分区：
文献类型：
--
作者：
Correia, Emanuel;Rodrigues, Bruno;Santos, Oliveira
目的：猝死风险分层是肥厚性心肌病（HCM）治疗中的一个主要问题。现有的风险因素具有较低的阳性预测值，需要新的参数。通过2D斑点追踪确定心肌变形（应变）是确定LV局部功能的新方法，可能与心肌组织紊乱和纤维化相关。本研究的目的是评估应变分析与HCM患者非持续性室性心动过速（NSVT）之间的关系。方法：32例连续HCM患者（平均年龄55岁，17-78岁）进行了研究。所有患者均接受标准超声心动图和二维应变检查。进行24小时霍尔特监测，并将超声心动图参数与NSVT进行相关性分析。结果：9例患者（28%）有一次或多次NSVT发作。非室上性心动过速患者的最大左室厚度值较高（23.6 mm vs. 19.4 mm，P = 0.027）。霍尔特监测的NSVT与左室流出道阶差、左房内径、E/Em和左室射血分数无明显相关性。HCM和NSVT患者的中间隔、顶部-间隔、顶部-外侧应变和平均纵向应变显著降低。中间隔应变>-10.5%预测NSVT的敏感性为89%，特异性为74%（曲线下面积为0.787; P < 0.0013），与年龄或最大室壁厚度无关。结论：2D斑点追踪法获得的收缩末期最大纵向应变较低，是HCM患者发生NSVT的预测指标。这个参数可能成为一个有用的工具，在分层SCD的风险在这一人群中。（超声心动图2011;28：709-714）
Aims: Stratifying risk of sudden death is a major issue in the management of hypertrophic cardiomyopathy (HCM). Existing risk factors have low positive predictive value and new parameters are needed. Determination of myocardial deformation (strain) by 2D Speckle tracking is a new methodology for determining LV regional function and could correlate with myocite disarray and fibrosis. The aim of this study was to assess the relationship between strain analysis and nonsustained ventricular tachycardia (NSVT) in patients with HCM. Methods: Thirty-two consecutive patients with HCM (mean age 55, 17-78) were studied. All underwent standard echocardiographic and two-dimensional strain examination. Twenty-four-hour Holter monitoring was performed and echocardiographic parameters were correlated with NSVT. Results: Nine patients (28%) had one or more episodes of NSVT. Patients with NSVT had a higher value of maximal LV thickness (23.6 mm vs. 19.4 mm, P = 0.027). There were no significant associations between NSVT on Holter monitoring and LV outflow gradient left atrial diameter, E/Em or left ventricle ejection fraction. Patients with HCM and NSVT had significant reductions in mid septal, apical-septal, apical-lateral strain, and in mean longitudinal strain. Midseptal strain >-10.5% had a sensitivity of 89% and a specificity of 74% (area under the curve, 0.787; P < 0.0013) for predicting NSVT independently of age or maximum wall thickness. Conclusion: Lower end-systolic peak longitudinal strain obtained by 2D speckle tracking was a predictor of NSVT in HCM patients. This parameter could become a useful tool in stratifying SCD risk in this population. (Echocardiography 2011;28:709-714)