Effects of Isolated Obesity on Left and Right Ventricular Function: A Tissue Doppler and Strain Rate Imaging Study

Objective: To determine the subclinical effects of isolated obesity and its duration on cardiac function by using routine echocardiography and tissue Doppler myocardial strain rate. Methods: Forty‐nine subjects were enrolled in this study; 29 with isolated obesity defined as a body mass index ≥30 kg/m² with no other cardiovascular comorbidities, and 20 nonobese controls. All subjects underwent two‐dimensional and Doppler echocardiography including tissue Doppler imaging and myocardial strain rate. Results: The average duration of obesity was 12.1 years (4–18 years). Abnormalities of left ventricular (LV) wall thickness, mass, diastolic function, and left atrial size were detected in obese individuals, despite having preserved ejection fractions. The LV global longitudinal peak strain rate was significantly lower in obese subjects compared to nonobese control subjects (1.07 ± 0.14 vs. 1.38 ± 0.12, P < 0.001). Using multivariate analysis, the duration of obesity (ß=−0.76, P < 0.001), body mass index (ß=−0.35, P = 0.023), and age (ß=−0.29, P = 0.009) were independent predictors of the decreased LV global longitudinal peak strain rate, while the duration of obesity (ß=−0.66, P < 0.001) and body mass index (ß=−0.28, P = 0.037) were independent predictors of the decreased right ventricular (RV) peak strain rate. Conclusion: The presence and the duration of obesity were associated with impairment of subclinical biventricular systolic and diastolic function. These findings have the potential to increase awareness of subclinical cardiac manifestations in patients with isolated obesity and influence their early management. (Echocardiography 2010;27:236‐243)     

Two‐Dimensional Longitudinal Strain and Strain Rate Imaging for Assessing the Right Ventricular Function in Patients with Mitral Stenosis

Background: Longitudinal two‐dimensional strain (L2DS) deformation is a novel technique that evaluates global and regional right ventricular (RV) function. The aim of the study was to investigate the systolic function of RV by using this method in patients with pure mitral stenosis (MS). Methods: Conventional echocardiography and L2DS analysis were performed in 45 MS patients and 21 healthy controls. For strain analysis apical four‐chamber views were obtained and by using a software system, peak systolic strain and strain rates were calculated off‐line in each segment. Results: The mean global longitudinal strain (GLS) of the whole RV (?20 ± 7 vs. ?24 ± 6%, P= 0.02) and mean GLS of the septum (?19 ± 7 vs. ?23 ± 5%, P = 0.03) were significantly reduced in the MS patients. Compared with the control group no significant change was determined in the mean GLS of the RV free wall (RVFW). While the mean global longitudinal strain rates (GLSR) of the entire RV and RVFW were similar between the groups, a significant difference in the mean GLSR of the septum (?1.2 ± 0.4 vs. ?1.5 ± 0.3 s^?1, P= 0.005) was determined in the patients with MS. A regional analysis demonstrated that MS patients had significantly reduced strain and strain rates in the basal and mid‐segments of the septum, whereas only lower strain values in the basal RVFW. Conclusions: RV systolic function evaluated by L2DS analysis in patients with MS has shown decreased global and segmental systolic functions. (ECHOCARDIOGRAPHY 2010;27:525‐533)     

肥胖对中年高血压患者左心结构和左室舒张功能的影响

肥胖对中年高血压患者左心结构和左室舒张功能的影响张健苏庆立金英兰李玉聪（秦皇岛市第一医院心内科０６６０００）ＥｆｅｃｔｓｏｆＯｂｅｓｉｔｙｏｎＶｅｎｔｒｉｃｕｌａｒＳｔｒｕｃｔｕｒｅａｎｄＤｉａｓｔｏｌｉｃＦｕｎｃｔｉｏｎｉｎＭｉｄｄｌｅ－ａｇｅｄＰ...     

Acute and Chronic Effects of Smoking on Myocardial Function in Healthy Heavy Smokers: A Study of Doppler Flow,Doppler Tissue Velocity,and Two‐Dimensional Speckle Tracking Echocardiography

Background: The purpose of the study was to evaluate the acute and chronic effect of smoking on left ventricular function in healthy heavy smokers by conventional Doppler flow, tissue Doppler, and two‐dimensional speckle tracking echocardiography (2D‐STE). Methods: Echocardiograms were performed in 42 healthy heavy (>20 cigarettes/day) smokers (age 34 ± 5 years), before (group SM‐1), 15 minutes (SM‐2) and 30 minutes (SM‐3) after starting smoking 2 cigarettes. Nonsmokers (n = 41, age 33 ± 4 years) served as controls. Transmitral flow, isovolumetric relaxation time (IVRT), and myocardial performance index (MPI) were measured. Tissue velocity measurements were averaged from lateral and septal mitral annulus. Longitudinal strain (GS), systolic (SRs), early diastolic (SRe), late diastolic (SRa), and isovolumetric relaxation (SRivr) strain rate were measured. The percent change in strain from end‐systole to the first one‐third of diastole (SI‐DI = [(GS ? strain at one‐third diastole)/GS] × 100) was also measured. Results: IVRT and MPI were increased and early diastolic mitral annular velocity was decreased in SM‐2; they returned to baseline in SM‐3. There was no difference in GS and SRs. SRe and SRivr were reduced in SM‐1 (P < 0.05), and remained significantly reduced in SM‐2 and SM‐3. SI‐DI was lower in SM‐1 (P = 0.011) and was further reduced in SM‐2 and SM‐3 (P < 0.001). Conclusion: Acute and chronic smoking inhalation has adverse effects on myocardial function in healthy heavy smokers. 2D‐STE is able to detect both baseline differences and late acute effects of smoking.     

多普勒组织显像技术评价左室舒张功能的研究进展

左室舒张功能障碍在心血管疾病中很常见,二尖瓣血流频谱是评价左室舒张功能障碍的经典方法,但存在不足。多普勒组织显像技术是一项应用多普勒原理分析心肌组织运动的新技术,包括心肌速度显像、定量组织速度显像、组织追踪以及应变/应变率,这些方法为评价左室舒张功能提供更多、更有益的信息。     

Assessment of Left Ventricular Systolic Function Using Color-Coded Tissue Doppler Echocardiography

Tissue Doppler echocardiography can be used to measure myocardial velocity data by using the Doppler shift data of ultrasound waves. Two methods have recently been described to calculate velocity data: pulsed tissue Doppler and color-coded tissue Doppler. This article focuses on color-coded tissue Doppler data to evaluate left ventricular systolic function. Technical considerations and validation studies are reviewed. Potential clinical applications of color-coded tissue Doppler are presented, including dobutamine stress echocardiography, assessment of left ventricular ejection dynamics using mitral annular velocity, and tissue Doppler assessment of cardiac transplant rejection.     

Systolic and Diastolic Ventricular Function Assessed by Tissue Doppler Imaging in Children with Chronic Kidney Disease

Chronic kidney disease (CKD) is associated with elevated cardiovascular risk even during childhood. Tissue Doppler is a sensitive technique for the assessment of ventricular dysfunction with relatively little data available in children with CKD. We report a prospective cross‐sectional echocardiographic study at a tertiary center. Forty‐nine patients with median (range) age 11.2 years (6.9–17.9), weight 39.6 kg (23.6–99.7) and height 146 cm (122–185). Thirty‐one patients were male. Median duration of follow‐up for CKD was 7.1 years (range 0.13–16.9). Patients were in CKD stage 3 (n = 37) or 4 (n = 12). Mitral valve E‐wave, A‐wave, and E/A ratio showed mean (SD) z‐scores of 0.08 (0.93), 0.12 (0.82) and ?0.13 (0.84), respectively. Tissue Doppler imaging (TDI) at the lateral mitral valve annulus showed e′, a′, s′, and E/e′ z‐scores mean (SD) ?1.10 (0.76), ?0.29 (0.92), ?1.2 (0.7), and 0.86 (1.1), respectively. There was a significant negative correlation of e′ and s′ z‐score with patient age. E/e′ ratio correlated positively with patient age. Blood pressure, left ventricular mass, and relative wall thickness did not correlate with tissue Doppler measurements. The e′ and s′ velocities correlated significantly with each other, suggesting an interaction of systolic and diastolic dysfunction. Children with CKD may have abnormalities of systolic and diastolic ventricular function on TDI, which are not evident on blood pool Doppler. The tissue Doppler results are consistent with worsening ventricular function in older patients.     

Quantification of Regional Left Ventricular Systolic Dysfunction in Patients With Coronary Artery Disease by Strain Rate Imaging

Objectives To detect and compare the systolic strain rate (SR) and strain in the infarct and ischemic myocardium by strain rate imaging (SRI), in order to explore the clinical value of SRI in evaluating regional left ventricular systolic dysfunction. Methods Patients with coronary artery disease were divided into angina pectoris (11 cases) and myocardial infarction (21 cases) groups. Twenty age-matched normal subjects served as the control group. Septal, lateral, anterior, inferior, anteroseptal and posterior walls of the left ventricle were respectively scanned using color tissue Doppler imaging (TDI). Then SR and strain curves were derived from TDI for basal, middle and apical segments of each wall. SRI parameters were: Systolic SR (SRsys), systolic strain (εsys) and maximum strain (εmax). Results Compared with normal segments, SRsys, εsys and εmax decreased significantly in the infarct and ischemic segments (P<0.01). Compared with ischemic segments, SRsys, εsys and εmax decreased significantly in the infarct segments (P<0.05). Conclusions SRsys, εsys and εmax measured by SRI can be used to quantitatively analyze regional left ventricular systolic dysfunction in patients with coronary artery disease, and aid in differentiating infarct from ischemic myocardium.     

Changes in Systolic and Diastolic Function Indexes Throughout Dobutamine Stress Echocardiography in Healthy Volunteers and Patients with Ischemic Heart Disease

BACKGROUND AND HYPOTHESIS: Dobutamine stress echocardiography is a well-established diagnostic method for investigating patients with suspected ischemic coronary disease. A positive test result is based on systolic parameters, but left ventricular filling parameters also are affected by myocardial ischemia. The aim of the present study was to study changes in both systolic and diastolic left ventricular variables throughout the test, including the period following it. METHODS AND RESULTS: Seven healthy control subjects (group I), 10 patients with chest pain but without significant coronary stenosis (group II), and 17 patients with significant coronary stenosis (group III) were entered in the study. Dobutamine stress echocardiography was performed according to a preset standardized protocol. Two-dimensional echocardiography and transmitral pulsed-Doppler images were stored for later analysis at rest, low dose, peak dose, and 5 minutes after termination of the dobutamine infusion. The wall motion score index increased from rest to low dose by 6.7% +/- 6.4% (P < 0.05) and to the peak dose by 39.1% +/- 9.9% (P < 0.001) in all three groups. The increase from rest to peak dose was significantly higher in groups I and II than in group III (P < 0.01). There was a significant increase in the atrial velocity-time integral (A-VTI) at peak dose in groups I and II (64.8% +/- 52.1% and 103.8% +/- 68.7%, respectively; P < 0.05 and <0.001), but no change in group III was noted. At the peak dose, A-VTI was significantly greater in groups I and II than in group III (P < 0.05). Among the 17 patients with proved coronary stenosis, 15 (88.2%) had a positive systolic response and 14 (82.3%) had a positive diastolic response, expressed as an A-VTI increase of 相似文献   

Subclinical Left Ventricular Dysfunction in Asymptomatic Severe Aortic Regurgitation Patients with Normal Ejection Fraction: A Combined Tissue Doppler and Velocity Vector Imaging Study

Objectives: Our aim was to evaluate subclinical left ventricular (LV) dysfunction, by two novel echocardiographic techniques, velocity vector imaging (VVI)‐derived strain imaging and tissue Doppler imaging (TDI), in patients with asymptomatic, severe aortic regurgitation (AR). Methods: Forty patients with severe AR with normal ejection fraction and 30 controls were included to the study. All patients underwent a standard echocardiography extended with TDI and VVI analyses. To evaluate the LV longitudinal and circumferential deformation, segmental systolic peak strain and strain rate (SRs) data were acquired from parasternal short axis, apical four‐chamber, two‐chamber, and long axis views, and additionally LV myocardial velocities, isovolumic myocardial acceleration (IVA), peak systolic velocity (Sa) and peak myocardial velocity during isovolumic contraction (IVV) assessed by TDI. Results: IVA was the only TDI‐derived parameter which was significantly impaired in AR patients (P = 0.0001). Both longitudinal and circumferential strain and SRs of the LV were significantly decreased in patients with severe AR (P = 0.0001). Longitudinal and circumferential strain/SRs and TDI‐derived LV IVA were inversely correlated with LV end‐diastolic diameter (P = 0.0001) and end‐systolic diameter (P = 0.0001). TDI‐derived IVA was also very well correlated with longitudinal deformation parameters (P = 0.0001). Conclusions: VVI‐ derived strain imaging and TDI‐derived IVA may be used as adjunctive, reliable, noninvasive parameters for evaluating subclinical ventricular dysfunction in patients with chronic, severe AR. This may help to identify patients for closer follow‐up and to determine the need for surgery before developing irreversible, severe heart failure. (Echocardiography 2010;27:260‐268)     

高血压右室与左室舒张功能的关系

对64例Ⅰ、Ⅱ期临床无心功能不全表现的高血压患者，32例年龄与性别相匹配的健康者，应用多普勒超声心动图技术，对其右室舒张功能进行测定，同时测定其左室收缩及舒张功能并作比较，高血压组按超声心动图标准分为左室肥厚组（LVH）34例，无左室肥厚组（NLVH）30例。测定结果表明,NLVH组与正常组比较，前者通过三尖瓣的E峰较低（P＜0.05），A峰较高（P＜0.05），E／A比值较小（P＜O.01)，快速充盈分数(PFF），l／3充盈数(1／3EF）和校正的充盈率峰值（PFR）也降低（P＜0.05），下降时间（DT）延长（P＜0.01）。LVH组中上述各参数与正常组比较也均有降低，与NLVH组比较A峰、E／A比值和PFR有进一步损害。相关分析发现，右室充盈参数与左室充盈参数密切相关（r从0.45到0.80）。     

Evaluation of Left Ventricle Function by Strain Imaging in Patients with Familial Mediterranean Fever

Aim: Familial Mediterranean Fever (FMF) is a hereditary inflammatory disease characterized by recurrent fever and serositis. We aimed to evaluate cardiac involvement in FMF patients by using strain and strain rate echocardiographic imaging method in this study. Materials and Methods: Echocardiographic evaluation was performed in 23 FMF patients and 22 healthy controls. FMF diagnosis was based on Tell‐Hashomer diagnostic criteria. Conventional echocardiography, tissue Doppler echocardiography and longitudinal two‐dimensional (2D) strain and strain rate imaging were performed in patient and control groups. Results: There were no significant differences between patient and control groups in terms of 2D, M‐mode, conventional Doppler and tissue Doppler velocities. Left ventricle strain value was significantly lower in five out of eight segments in FMF patients than controls and left ventricle strain rate value was significantly lower in three out of eight segments in FMF patients than controls. Mean left ventricle strain value was significantly lower in FMF patients than controls (–21.1 ± 2.2% vs. –23.8 ± 2.2%; P < 0.001). No significant difference was noted between FMF patients and controls in mean left ventricle strain rate value (–1.61 ± 0.23 vs. –1.58 ± 0.21; P = 0.48). Conclusion: We have shown that although conventional echocardiography and tissue Doppler velocity data were similar, strain, strain rate values were significantly lower in FMF patients than controls. We know that strain and strain rate imaging method might be useful for evaluating subclinical cardiac involvement in case of normal conventional and tissue Doppler velocity data in patients with FMF. (Echocardiography 2010;27:1056‐1060)