The present study investigated the changes of biventricular mechanics at rest and during exercise and examined the association between exercise capacity and biventricular mechanics and functional reserve in nonobstructive hypertrophic cardiomyopathy (NHCM) patients. A total of 50 NHCM patients and 25 controls were consecutively recruited for this study. Using echocardiography and two-dimensional speckle-tracking imaging, an experienced echocardiographer determined the following indices: RV free wall longitudinal strain (RVFWLS), LV global longitudinal strain (LVGLS), strain rate (SR), and functional reserve of strain values. We also investigated the relationships between biventricular mechanics and exercise capacity using metabolic equivalents (METs). NHCM patients had lower RVFWLS, LVGLS, systolic SR, early diastolic SR, and systolic and diastolic reserve during exercise compared to controls. An association of biventricular mechanics (LVGLS, RVFWLS) with exercise capacity at rest and during exercise was established. Multivariable logistic regression revealed that RVFWLS and LVE/e' during exercise (RVFWLS-exe, E/e'-exe) were independent predictors of exercise intolerance. Receiver operating characteristic curve analysis indicated that LVE/e'-exe had a higher area under the curve for predicting exercise intolerance in NHCM patients. In hierarchical analysis, RVFWLS-exe provided an incremental predictive value of exercise intolerance over LVGLS during exercise (LVGLS-exe) and LVE/e'-exe. LVE/e'-exe also changed incrementally compared to LVGLS-exe and RVFWLS-exe. NHCM patients have decreased biventricular mechanics at rest and during exercise and impaired biventricular functional reserve, and biventricular mechanics are associated with functional capacity. We propose that simultaneous evaluation of biventricular function should provide incremental predictive value for exercise intolerance.

译文

:本研究调查了非阻塞性肥厚型心肌病(NHCM)患者在休息和运动过程中双心室力学的变化,并研究了运动能力与双心室力学与功能储备之间的关系。连续招募了总共50名NHCM患者和25名对照。经验丰富的超声心动图医师使用超声心动图和二维斑点跟踪成像技术确定以下指标:RV无壁纵向应变(RVFWLS),LV整体纵向应变(LVGLS),应变率(SR)和应变值的功能储备。我们还使用代谢当量(METs)研究了双心室力学与运动能力之间的关系。与对照组相比,NHCM患者运动期间的RVFWLS,LVGLS,收缩期SR,早期舒张期SR以及收缩期和舒张期储备较低。建立了双心室力学(LVGLS,RVFWLS)与静止和运动期间的运动能力的关联。多变量logistic回归显示运动期间的RVFWLS和LVE / e'(RVFWLS-exe,E / e'-exe)是运动耐量的独立预测因子。受试者工作特征曲线分析表明,LVE / e'-exe在曲线下具有较高的面积,可预测NHCM患者的运动耐量。在分级分析中,RVFWLS-exe提供了运动耐力优于运动期间LVGLS(LVGLS-exe)和LVE / e'-exe的递增预测值。与LVGLS-exe和RVFWLS-exe相比,LVE / e'-exe也发生了增量变化。 NHCM患者在休息和运动期间双心室力学下降,双心室功能储备受损,并且双心室力学与功能能力相关。我们建议同时评估双心室功能应为运动不耐症提供递增的预测价值。

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