Early Detection of Left Ventricular Systolic Dysfunction

chocardiography. 2012 September; 29(8): 927–932.
Published online 2012 May 29. doi: 10.1111/j.1540-8175.2012.01717.x
PMCID: PMC3465776
Early Detection of Left Ventricular Systolic Dysfunction Using Two-Dimensional
Speckle Tracking Strain Evaluation in Healthy Subjects after Acute Alcohol
Intoxication
Patricia Reant, M.D., Ph.D., Warren Chasseriaud, M.D., Xavier Pillois, Ph.D., Marina Dijos, M.D., Florence Arsac,
M.D., Raymond Roudaut, M.D., and Stephane Lafitte, M.D., Ph.D.
Author information ► Copyright and License information ►
Abstract
Objectives: We evaluated the ability of two-dimensional speckle tracking strain
echocardiography to detect left ventricular (LV) systolic dysfunction as compared with
LV ejection fraction (EF) in healthy subjects following acute alcohol intoxication.
Methods and Results: In total, 25 healthy subjects were investigated using
echocardiography 4–6 hours after the onset of alcohol intoxication at a regional festive
gathering, and then compared to 23 healthy control subjects without alcohol
consumption. Heart rate, blood pressure, blood alcohol level, LV volumes, EF,
shortening fraction, E/A ratio, as well as global longitudinal strain (LS) were recorded.
Mean blood alcohol level was 1.3 ± 0.3 g.L−1. Mean systolic blood pressure and heart
rate were slightly increased in the alcohol group compared to controls (147.5 ± 21.8
mmHg vs 127.0 ± 9.9 mmHg, P = 0.003, and 79.7 ± 10.7 bpm vs 70.6 ± 7.6 bpm, P <
0.001, respectively). While there was no significant difference in terms of LVEF (62.9 ±
4.4% vs 64.8 ± 5.9%, P = 0.18) or shortening fraction (34.7 ± 5.9% vs 36.0 ± 4.3%, P =
0.54), global LS was significantly impaired (–17.8 ± 2.0% vs −21.2 ± 1.8%, P < 0.001).
In addition, subjects who consumed alcohol had increased LV end-diastolic (108.3 ± 20.1
mL vs 95.5 ± 14.6 mL, P = 0.037) and end-systolic volumes (41.6 ± 11.4 mL vs 33.7 ±
6.9 mL, P = 0.024), along with depressed aortic time-velocity integral (19.9 ± 3.2 mL vs
21.9 ± 2.5 mL, P = 0.034). According to multivariate linear regression analyses, blood
alcohol level was the only factor significantly associated with global LS (β=−3.6 ± 1.0, P
= 0.005). Conclusion: Alcohol intoxication around festive days induces acute LV
contraction abnormalities, which may be detected using global LS by speckle tracking at
an earlier stage and more accurately than LVEF decreases.
1
Keywords: binge
drinking,
speckle
tracking
strain
echocardiography,
alcohol
intoxication
Previous studies have reported a depression in left ventricular (LV) contractility after
acute ethanol consumption based on invasive hemodynamic approaches,1 systolic timeinterval evaluation (preejection period/LV ejection time),2,3 or ejection fraction (EF) by
echocardiography.4 In studies on animals and healthy subjects, alcohol intoxication was
shown to cause a dose-dependent impairment of cardiac contractility,5,6 with systemic
inflammatory responses being considered as one of the pathophysiological mechanisms.
A recent clinical magnetic resonance imaging (MRI) study reported a reversible
myocardial injury with myocardial hyperenhancement after binge drinking, but without
any decrease in LV systolic function.7
Myocardial deformation analysis using two-dimensional (2D) speckle tracking
echocardiography has already been validated, showing high levels of reproducibility and
accuracy in detecting subtle early LV systolic function abnormalities (depressed
longitudinal deformation) in heart disorder patients without an altered EF.8–14
Therefore, our study aimed to investigate the ability of 2D speckle tracking strain
echocardiography to detect early LV systolic dysfunction as compared with conventional
LVEF evaluation in healthy subjects after acute alcohol intoxication versus a control
group of healthy nonintoxicated subjects.
Methods
Study Protocol
During a regional festive gathering, consecutive healthy men subjects admitted to the aid
station were consecutively evaluated by the same observer using echocardiography, 3 to
4 hours after the onset of acute alcohol intoxication.
A control group of volunteers, comprising medical students at our University Cardiologic
Hospital, was recruited, given the condition that they had not consumed any alcohol for
at least 10 days prior to the study.
To be eligible as healthy subjects, subjects had to be free from any known cardiovascular
disease, diabetes, and hypertension.
2
The study excluded subjects presenting insufficient ultrasound image quality, defined as
more than three LV segments being suboptimally visualized by conventional
echocardiography.
Echocardiographic measurements were performed by a second observer, blinded to the
subjects’ levels of alcohol consumption.
Systolic and diastolic blood pressures, heart rate, and blood alcohol level were
systematically measured immediately prior to the echocardiography.
In order to estimate the blood alcohol levels, a portable breathalyzer approved by the
National Authorities was used, with measurements being repeated three times and their
mean values determined.
Written informed consent was obtained from all subjects. In accordance with the local
ethical guidelines, this observational study was designed to be performed in the context
of popular festivities.
Transthoracic Echocardiographic Data Acquisitions
The subjects were examined in the left lateral decubitus position using a Vivid Q
commercial ultrasound scanner (General Electric Healthcare, Haifa, Israel) with phasedarray transducers (M4S-RS).
Thereafter, 2D data acquisitions were obtained, including parasternal long- and short-axis
views and three standard apical views. For each view, three consecutive cardiac cycles
were recorded during quiet respiration. Grey-scale recordings were optimized for LV
evaluation at a mean frame rate of at least 50 sec−1. Color Doppler recordings were
obtained in order to exclude valvular dysfunction, and Doppler flow recordings were
performed with a horizontal sweep velocity of 100 mm/sec.
Echocardiographic Analysis
All standard measurements were taken by the same observer using dedicated software
(EchoPac PC, version BT11; General Electric Medical Systems, Horten, Norway),
including percentage of LV fractional shortening, LV outflow tract time-velocity
integral, peak velocity of E- and A- waves of the mitral inflow, as well as tissue Doppler
analysis of max velocity E’ peak at the lateral mitral annulus. E/E’ ratio was calculated to
3
represent LV end-diastolic pressure. Based on apical four- and two-chamber views, LV
volumes and EF were measured according to Simpson's rule. All measurements were
made by averaging three cardiac cycles.
For longitudinal strain (LS) analysis, the software automatically tracked the contour on
subsequent frames after three endocardial markers were placed in an end-diastolic frame.
Adequate tracking could be verified in real time and corrected by adjusting the region of
interest or manually correcting the contour so as to ensure optimal tracking. In addition,
LS was assessed in apical views. Average LS was calculated for the 17 segments in
relation to the strain magnitude at aortic valve closure. Longitudinal systolic deformation
was characterized as shortening, and using the strain definition, systolic indices yielded a
negative value.
Reproducibility
The second observer performed all the echocardiographic measurements, which were
later repeated blindly for each parameter. The data were also analyzed by a third blinded
observer for 10 of the subjects. Intraobserver reproducibility was calculated using the
average difference between 10 measurements, and interobserver reproducibility was
assessed as the absolute difference divided by the average of the two observations for all
parameters.
Statistical Analysis
All statistical analyses were performed using SPSS for Windows (version 15.0, SPSS
Inc., Chicago, IL, USA). All data were expressed as mean ± standard deviation.
Between-group comparisons were made using paired t-tests or the Mann-Whitney test
where necessary. A P-value of <0.05 was considered statistically significant. Univariate
and multivariate linear regression analyses were performed in order to identify potential
links with global LS. The following independent variables were examined: systolic and
diastolic blood pressure, heart rate, blood alcohol level, LV shortening fraction, biplane
LV end-diastolic volume, biplane LVEF, aortic time-velocity integral, and E/E’.
4
Results
Study Population
Among the 25 screened subjects with acute alcohol intoxication, two were excluded from
the analysis on account of having at least nonvisualized three LV segments, considered to
be of insufficient image quality. The healthy controls without alcohol consumption
consisted of 23 subjects.
The population participants who consumed alcohol were all men, with a mean age of 25
± 8 years. Mean blood alcohol level was of 1.3 ± 0.3 g.L−1. Mean systolic blood pressure
and heart rate were slightly higher in the alcohol group compared to controls, with the
differences being statistically significant (147.5 ± 21.8 mmHg vs 127.0 ± 9.9 mmHg, P =
0.003, and 79.7 ± 10.7 bpm vs 70.6 ± 7.6 bpm, P < 0.001, respectively). Clinical
characteristics of the two study groups are summarized in Table I.
TABLE I
Clinical and Echocardiographic Characteristics of the Population
Echocardiographic Measurements
Echocardiographic characteristics of the study population are summarized in Table I.
There was no significant difference between the subjects who did and did not consume
alcohol in terms of LVEF (62.9 ± 4.4% vs. 64.8 ± 5.9%, P = 0.18) or LV shortening
fraction (34.7 ± 5.9% vs. 36.0 ± 4.3%, P = 0.54).
However, global LS was significantly lower in subjects with alcohol intoxication (–17.8
± 2.0% vs −21.2 ± 1.8%, P < 0.001), larger LV volumes (P < 0.05), and lower aortic
time-velocity integral. There was no linear relation between global LS and LV volumes
5
or blood pressure, nor was there any correlation between blood alcohol levels and clinical
or other echocardiographic parameters.
Reproducibility
Mean intra- and interobserver variability of global LS was 7% and 8%, respectively.
Regression Analyses
The results of univariate analysis (P-values) for the different parameters and their relation
to global LS are provided in Table II. Systolic blood pressure, blood alcohol level, LV
shortening fraction, end-diastolic and end-systolic LV volumes, EF, and time-velocity
integral were significantly linked to global LS.
TABLE II
Analyses of Association with Altered Global Longitudinal Strain
In a multivariate analysis, regarding the separate contribution to global LS of each
parameter among all parameters selected, only alcohol intoxication was found to
significantly and inversely contribute to global LS (β=−3.6 ± 1.0, P = 0.005) (Table II).
Figure 1 shows an example of GLS analysis in a control subject (A) and intoxicated
subject (B).
Figure 1
Example of longitudinal strain in healthy subjects without A. and with B. alcohol
intoxication. A. Global longitudinal strain in a healthy control subject without alcohol
consumption, and B. global longitudinal strain in a healthy subject with alcohol ...
6
Discussion
In this study, our main finding was that myocardial LS analysis using 2D speckletracking echocardiography allowed us to detect early LV systolic dysfunction
immediately after acute alcohol intoxication in men, whereas LVEF and LV shortening
fraction did not differ from those of control healthy subjects.
Capacity of Global LS to Detect LV Dysfunction Earlier than LVEF and Shortening
Fraction in Different Pathophysiological Situations
The conventional evaluation of LV systolic function by means of shortening fraction or
EF is limited by the percentage variability of measurements (10–15%). The assessment
of LV longitudinal deformation using 2D speckle tracking has been largely validated
against sonomicrometry and MRI as reference methods.8,9 Speckle tracking allows for a
quick and easy quantification (<1 min), with greater reproducibility (7% intraobserver
variability in our experience) than LVEF or shortening fraction.
Moreover, global LS analysis, also known as automated function imaging, permits the
exploration of the myocardial pathophysiology in new ways, particularly by detecting
early alterations in the longitudinal component of LV systolic function, while the radial
component is considered normal.10–12 These findings are observed with normal ageing as
well as with the typical precursors of heart failure with a normal EF, as seen in
hypertension, diabetes, hypertrophic cardiomyopathy, severe aortic stenosis, and
ischemia.10–15 In hypertensive patients, interstitial and perivascular fibrosis is likely to
affect primarily the subendocardium. Longitudinal fibers, as a consequence of their
prominent subendocardial location, are more vulnerable to fibrosis and hemodynamic
overload. Thus, subendocardial long-axis function may be impaired long before circular
fiber dysfunction develops in the midwall or radial fiber dysfunction in the subepicardial
layers. Consequently, subendocardial long-axis function is viewed as a potential marker
of subclinical LV dysfunction in several disease conditions.13,14 Similarly, longitudinal
fibers are more susceptible to ischemia than radial fibers. Thus, there appears to be an
entire spectrum of systolic function abnormalities, ranging from normal systolic heart
function to systolic heart failure, with heart failure with normal EF being located in
between.
7
Effects of Acute Alcohol Intoxication on LV Function
In studies on animals and healthy subjects, alcohol intoxication was shown to cause a
dose-dependent impairment of cardiac contractility,5,6 with systemic inflammatory
responses
being
considered
as
one
of
the
underlying
pathophysiological
16
mechanisms. Ethanol may modify cell activation by specific interactions with cell
membrane molecules, thereby involving the innate immune system.16
Several published studies reported a depression in LV contractility following acute
ethanol consumption based on invasive hemodynamic approaches,1 systolic time-interval
evaluation (preejection period/LV ejection time),2,3 or EF by echocardiography.4
Delgado et al. investigated the effects of oral doses of whiskey on LV function in a group
of normal volunteers (n = 13).4 At 30 min after ingesting the alcohol, the heart rate was
increased by 11%, while the fractional change across the minor axis of the LV decreased
by 6% and LVEF by 4% (P < 0.001). These results, however, have to be interpreted with
caution, given the small sample size and considering that LVEF measurements exhibit
10–15% variability, particularly when using echocardiographic systems from the mid1970s. By contrast, variability of global LS measurements approximated 7%, as based on
our own experience.
More recently, a clinical MRI study reported a reversible myocardial injury as defined by
myocardial hyperhancement after binge drinking, but without any concomitant decrease
in LV systolic function.7This latter study demonstrated that alcohol had no significant
effect on LVEF immediately after acute alcohol intoxication, in line with our own
observation. Consequently, radial function may be preserved in the initial phase, whereas
the longitudinal component could possibly be altered at an earlier stage, which is mainly
accounted for by the greater radius of curvature of longitudinal fibers as compared to
radial fibers (Laplace's law). Due to the greater radius curvature, the longitudinal
myofibers are deemed more susceptible to the different phenomena altering LV
contractility compared to radial fibers.
Limitations
LVEF was evaluated in 2D using biplane Simpson's method, although 3D volume
quantification might have been more accurate for quantifying EF and volumes. As only
male subjects were included in our study, the effects of alcohol intoxication on LV
8
systolic function in women were not assessed. In this study, we did not perform serial
echocardiography on the alcohol intoxicated subjects. This should have strengthened our
results.
Preload and afterload modifications may exert an impact on LV strains. In severe aortic
stenosis or hypertensive cardiopathy, afterload elevation was shown to influence more
specifically the longitudinal component of LV systolic function, due to the greater radius
of curvature of longitudinal fibers. Soon after alcohol intoxication in healthy subjects,
blood pressure, heart rate, and volumes were shown to be increased. We, therefore,
assumed that preload and afterload elevations may have an impact on global LS.
However, multivariate regression analyses demonstrated that blood alcohol levels alone
were significantly related to global LS, whereas blood pressure, heart rate, LVEF, and
LV volumes were not.
Conclusions
Global LS by speckle tracking echocardiography allows for a more accurate detection of
early LV systolic dysfunction after festive alcohol intoxication compared to LVEF, with
the results being independent from blood pressure, heart rate, and LV volumes variations.
References
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blockade. Circulation. 1979;59:120–125. [PubMed]
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echocardiography. Circulation. 1975;51:535–540. [PubMed]
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6. Kelbaek H, Gjørup T, Brynjolf I, et al. Acute effects of alcohol on left ventricular function in healthy subjects at rest
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resonance imaging. JAMA. 2010;304:1328–1330. [PubMed]
8. Leitman M, Lysyansky P, Sidenko S, et al. Two-dimensional strain- a novel software for real-time quantitative
echocardiographic assessment of myocardial function. J Am Soc Echocardiogr.2004;17:1021–1029. [PubMed]
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9. Amundsen BH, Helle-Valle T, Edvardsen T, et al. Noninvasive myocardial strain measurement by speckle tracking
echocardiography: Validation against sonomicrometry and tagged magnetic resonance imaging. J Am Coll
Cardiol. 2006;47:789–793. [PubMed]
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prognosis in patients with asymptomatic aortic stenosis. Eur J Echocardiogr.2009;10:414–419. [PubMed]
12. Reant P, Lafitte S, Bougteb H, et al. Effect of catheter ablation for isolated paroxysmal atrial fibrillation on
longitudinal and circumferential left ventricular systolic function. Am J Cardiol.2009;103:232–237. [PubMed]
13. Sanderson JE. Heart failure with a normal ejection fraction. Heart. 2007;93:155–158.[PMC free article] [PubMed]
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heart disease. Clin Sci (Lond) 2004;106:53–60. [PubMed]
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chocardiography . 2012 September , 29 ( 8 ) : 927-932 .
Diterbitkan online 2012 Mei 29. doi : 10.1111/j.1540-8175.2012.01717.x
PMCID : PMC3465776
Deteksi Dini Kiri ventrikel sistolik Disfungsi Menggunakan Dua Dimensi Speckle Pelacakan Evaluasi Galur di Subjek
Sehat setelah intoksikasi akut Alkohol
Patricia Reant , MD , Ph.D. , Warren Chasseriaud , MD , Xavier Pillois , Ph.D. , Marina Dijos , MD , Florence Arsac ,
MD , Raymond Roudaut , MD , dan Stephane Lafitte , MD , Ph.D.
Informasi Penulis ► Hak Cipta dan Informasi Lisensi ►
abstrak
Tujuan : Kami mengevaluasi kemampuan dua dimensi belu pelacakan regangan
echocardiography untuk mendeteksi ventrikel kiri ( LV ) disfungsi sistolik dibandingkan
dengan fraksi ejeksi LV ( EF ) pada subyek sehat setelah keracunan alkohol akut .
Metode dan Hasil : Secara total , 25 subyek sehat diselidiki menggunakan
echocardiography 4-6 jam setelah timbulnya keracunan alkohol pada pertemuan meriah
regional, dan kemudian dibandingkan dengan 23 subyek kontrol sehat tanpa konsumsi
alkohol . Denyut jantung, tekanan darah , kadar alkohol , volume LV , EF , fraksi
pemendekan , E / rasio A , serta ketegangan membujur dunia ( LS ) dicatat. Berarti
tingkat alkohol darah adalah 1,3 ± 0,3 g.L - 1 . Berarti tekanan darah sistolik dan denyut
jantung yang sedikit meningkat pada kelompok alkohol dibandingkan dengan kontrol (
147,5 ± 21,8 mmHg vs 127,0 ± 9,9 mmHg , P = 0,003 , dan 79,7 ± 10,7 vs 70,6 ± bpm
7,6 bpm , P < 0,001 , masing-masing) . Sementara tidak ada perbedaan yang signifikan
dalam hal LVEF ( 62,9 ± 4,4 % vs 64,8 ± 5,9 % , P = 0,18 ) atau fraksi shortening ( 34,7
± 5,9 % vs 36,0 ± 4,3 % , P = 0.54 ) , LS global gangguan signifikan ( -17,8 ± 2,0 % vs 21,2 ± 1,8 % , P < 0,001 ) . Selain itu, subyek yang mengkonsumsi alkohol telah
meningkat LV akhir diastolik ( 108,3 ± 20,1 mL vs 95,5 ± 14,6 mL , P = 0,037 ) dan
volume akhir sistolik ( 41,6 ± 11,4 mL vs 33,7 ± 6,9 mL , P = 0,024 ) , bersama dengan
depresi aorta waktu - kecepatan integral ( 19,9 ± 3,2 mL vs 21,9 ± 2,5 mL , P = 0,034 ) .
Menurut multivariat analisis regresi linier , tingkat alkohol darah adalah satu-satunya
faktor signifikan yang berkaitan dengan dunia LS ( β = -3.6 ± 1.0 , P = 0,005 ) .
Kesimpulan : keracunan Alkohol sekitar hari-hari perayaan menginduksi kontraksi LV
11
kelainan akut, yang dapat dideteksi menggunakan LS global dengan belu pelacakan pada
tahap awal dan lebih akurat daripada LVEF menurun .
Kata kunci : pesta minuman keras , belu pelacakan ketegangan echocardiography ,
keracunan alkohol
Studi sebelumnya telah melaporkan depresi dalam ventrikel kiri ( LV ) kontraktilitas
setelah konsumsi etanol akut didasarkan pada pendekatan hemodinamik invasif , 1
sistolik evaluasi interval waktu ( periode preejection / LV waktu ejeksi ) , 2,3 atau fraksi
ejeksi ( EF ) dengan echocardiography . 4 Dalam studi pada hewan dan subyek sehat ,
alkohol keracunan terbukti menyebabkan penurunan dosis-tergantung dari kontraktilitas
jantung , 5,6 dengan respon inflamasi sistemik yang dianggap sebagai salah satu
mekanisme patofisiologi . Sebuah pencitraan resonansi magnetik studi klinis terbaru (
MRI ) melaporkan cedera miokard reversibel dengan hyperenhancement miokard setelah
pesta minuman keras , tetapi tanpa penurunan LV sistolik function.7
Analisis deformasi miokard menggunakan dua dimensi ( 2D ) spekel echocardiography
pelacakan telah divalidasi , menunjukkan tingkat tinggi reproduktifitas dan akurasi dalam
mendeteksi halus awal LV sistolik kelainan fungsi ( deformasi memanjang depresi ) pada
pasien gangguan jantung tanpa diubah EF.8 - 14
Oleh karena itu , penelitian kami bertujuan untuk mengetahui kemampuan 2D belu
pelacakan regangan echocardiography untuk mendeteksi dini LV sistolik disfungsi
dibandingkan dengan evaluasi LVEF konvensional pada subyek sehat setelah keracunan
alkohol akut versus kelompok kontrol subyek nonintoxicated sehat .
metode
studi Protokol
Selama pertemuan meriah regional, berturut-turut subjek pria sehat dirawat di pusat
kesehatan secara berurutan dievaluasi oleh pengamat yang sama menggunakan
echocardiography , 3 sampai 4 jam setelah timbulnya keracunan alkohol akut .
Sebuah kelompok kontrol relawan , yang terdiri dari mahasiswa kedokteran di kami
kardiologi University Hospital , direkrut , mengingat kondisi bahwa mereka tidak
mengkonsumsi alkohol setidaknya 10 hari sebelum studi .
12
Untuk memenuhi syarat sebagai subyek sehat , subyek harus bebas dari penyakit yang
dikenal jantung, diabetes , dan hipertensi .
Penelitian ini dikecualikan subyek menyajikan cukup USG kualitas gambar , yang
didefinisikan sebagai lebih dari tiga segmen LV yang suboptimally divisualisasikan
dengan ekokardiografi konvensional .
Pengukuran echocardiographic dilakukan oleh pengamat kedua , buta ke tingkat subyek '
dari konsumsi alkohol .
Sistolik dan diastolik tekanan darah, denyut jantung , dan tingkat alkohol darah secara
sistematis diukur segera sebelum echocardiography tersebut .
Dalam rangka untuk memperkirakan tingkat alkohol darah, Breathalyzer portabel
disetujui oleh Otoritas Nasional digunakan , dengan pengukuran yang diulang tiga kali
dan nilai rata-rata mereka ditentukan .
Informed consent tertulis diperoleh dari semua mata pelajaran . Sesuai dengan pedoman
etika lokal , studi observasional dirancang untuk dilakukan dalam konteks perayaan
populer .
Transtorakal ekokardiografi Akuisisi data
Subyek diperiksa pada posisi dekubitus lateral kiri menggunakan Q scanner ultrasound
komersial Vivid ( General Electric Healthcare , Haifa , Israel ) dengan bertahap-array
transduser ( M4S - RS ) .
Setelah itu , akuisisi data yang 2D diperoleh , termasuk pandangan jangka panjang dan
pendek sumbu parasternal dan tiga tampilan apikal standar. Untuk setiap tampilan , tiga
siklus berturut-turut jantung dicatat selama respirasi tenang. Rekaman Grey- skala yang
dioptimalkan untuk evaluasi LV pada frame rate rata-rata minimal 50 detik - 1 . Warna
Doppler rekaman diperoleh untuk mengecualikan disfungsi katup , dan rekaman aliran
Doppler dilakukan dengan sapuan kecepatan horizontal dari 100 mm / detik .
Analisis echocardiographic
Semua pengukuran standar diambil oleh pengamat yang sama menggunakan perangkat
lunak khusus ( EchoPac PC , versi BT11 , Listrik Sistem Pengobatan Umum , Horten ,
Norwegia ) , termasuk persentase LV memperpendek pecahan , LV saluran keluar waktu
13
- kecepatan terpisahkan , kecepatan puncak E - dan A- gelombang masuknya mitral ,
serta analisis Doppler jaringan max kecepatan E ' puncak pada anulus mitral lateral. E / E
' rasio dihitung untuk mewakili LV tekanan akhir diastolik . Berdasarkan apikal empat
dan dua ruang pandangan, volume LV dan EF diukur sesuai dengan Aturan Simpson .
Semua pengukuran dilakukan dengan rata-rata tiga siklus jantung .
Untuk membujur regangan ( LS ) analisis , perangkat lunak secara otomatis melacak
kontur pada frame berikutnya setelah tiga penanda endokardium ditempatkan dalam
kerangka akhir diastolik . Pelacakan yang memadai dapat diverifikasi secara real time
dan dikoreksi dengan menyesuaikan daerah bunga atau manual dengan memperbaiki
kontur sehingga untuk memastikan pelacakan yang optimal . Selain itu, LS dinilai dalam
pandangan apikal . LS Rata-rata dihitung untuk 17 segmen dalam kaitannya dengan
besarnya regangan pada penutupan katup aorta . Deformasi sistolik Longitudinal ditandai
sebagai shortening , dan menggunakan definisi regangan , indeks sistolik menghasilkan
nilai negatif .
reproduktifitas
Para pengamat kedua melakukan semua pengukuran echocardiographic , yang kemudian
diulang membabi buta untuk setiap parameter . Data juga dianalisis oleh pengamat buta
ketiga 10 dari subyek . Intraobserver reproduksibilitas dihitung menggunakan perbedaan
rata-rata antara 10 pengukuran , dan interobserver reproduktifitas dinilai sebagai
perbedaan mutlak dibagi dengan rata-rata dua pengamatan untuk semua parameter .
Analisis Statistik
Semua analisa statistik dilakukan dengan menggunakan program SPSS for Windows (
versi 15.0 , SPSS Inc , Chicago , IL , USA ) . Semua data dinyatakan sebagai rata-rata ±
standar deviasi .
Perbandingan antara kelompok dibuat menggunakan paired t - tes atau uji Mann Whitney jika diperlukan . Sebuah P-nilai < 0,05 dianggap signifikan secara statistik .
Analisis regresi linier univariat dan multivariat dilakukan untuk mengidentifikasi link
potensial dengan LS global. Variabel independen berikut diperiksa : tekanan darah
sistolik dan diastolik , denyut jantung , kadar alkohol , shortening fraksi LV , biplan LV
volume akhir diastolik , LVEF biplan , aorta waktu - kecepatan terpisahkan , dan E / E ' .
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hasil
studi Populasi
Di antara 25 mata pelajaran disaring dengan keracunan alkohol akut , dua dikeluarkan
dari analisis karena memiliki setidaknya nonvisualized tiga segmen LV , dianggap
kualitas gambar cukup . Kontrol sehat tanpa konsumsi alkohol terdiri dari 23 mata
pelajaran .
Para peserta penduduk yang mengkonsumsi alkohol semua laki-laki , dengan usia ratarata 25 ± 8 tahun . Berarti tingkat alkohol dalam darah adalah 1,3 ± 0,3 gL - 1 . Berarti
tekanan darah sistolik dan denyut jantung yang sedikit lebih tinggi pada kelompok
alkohol dibandingkan dengan kontrol , dengan perbedaan-perbedaan yang signifikan
secara statistik ( 147,5 ± 21,8 mmHg vs 127,0 ± 9,9 mmHg , P = 0,003 , dan 79,7 ± 10,7
vs 70,6 ± bpm 7,6 bpm , P <0,001 , masing-masing) . Karakteristik klinis dari dua
kelompok belajar diringkas dalam Tabel I.
TABEL I
Karakteristik klinis dan ekokardiografi dari Penduduk
Pengukuran echocardiographic
Karakteristik echocardiographic populasi penelitian dirangkum dalam Tabel I. Tidak ada
perbedaan yang signifikan antara subyek yang melakukan dan tidak mengkonsumsi
alkohol dalam hal LVEF ( 62,9 ± 4,4 % vs 64,8 ± 5,9 % , P = 0,18 ) atau LV shortening
fraksi ( 34,7 ± 5,9 % vs 36,0 ± 4,3 % , P = 0.54 ) .
Namun, LS global yang secara signifikan lebih rendah pada subyek dengan keracunan
alkohol ( -17,8 ± 2,0 % vs -21,2 ± 1,8 % , P < 0,001 ) , volume LV lebih besar ( P <0,05 )
, dan bawah aorta waktu - kecepatan terpisahkan . Tidak ada hubungan linear antara LS
global dan volume LV atau tekanan darah , juga tidak ada hubungan antara tingkat
alkohol dalam darah dan parameter echocardiographic klinis atau lainnya .
reproduktifitas
Berarti intra dan interobserver variabilitas LS global 7 % dan 8 % , masing-masing.
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Analisis regresi
Hasil analisis univariat ( P - nilai ) untuk parameter yang berbeda dan hubungannya
dengan LS global pada Tabel II . Tekanan darah sistolik , kadar alkohol , shortening
fraksi LV , akhir diastolik dan akhir sistolik volume LV , EF , dan integral waktu kecepatan secara signifikan terkait dengan LS global.
TABEL II
Analisis Asosiasi dengan Diubah Regangan longitudinal global
Dalam analisis multivariat , mengenai kontribusi terpisah untuk LS global setiap
parameter antara semua parameter yang dipilih , hanya keracunan alkohol ditemukan
secara signifikan dan berbanding terbalik berkontribusi LS dunia ( β = -3.6 ± 1.0 , P =
0,005 ) ( Tabel II ) .
Gambar 1 menunjukkan contoh analisis GLS di subjek kontrol ( A ) dan tunduk mabuk (
B).
Gambar 1
Contoh regangan longitudinal pada subyek sehat tanpa A. dan B. dengan keracunan
alkohol . A. global regangan longitudinal pada subjek kontrol sehat tanpa konsumsi
alkohol , dan B. ketegangan membujur global dalam subjek yang sehat dengan alkohol ...
diskusi
Dalam studi ini , Temuan utama kami adalah bahwa analisis LS miokard menggunakan
2D belu - pelacakan echocardiography memungkinkan kami untuk mendeteksi dini LV
sistolik disfungsi segera setelah keracunan alkohol akut pada pria , sedangkan LVEF dan
shortening fraksi LV tidak berbeda dari subyek sehat kontrol.
Kapasitas LS Global Mendeteksi LV Disfungsi Awal dari LVEF dan Shortening Fraksi
dalam Situasi patofisiologi Berbeda
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Evaluasi konvensional LV fungsi sistolik dengan cara memperpendek fraksi atau EF
dibatasi oleh persentase variabilitas pengukuran ( 10-15 % ) . Penilaian deformasi
memanjang LV menggunakan 2D Speckle pelacakan sebagian besar telah divalidasi
terhadap sonomicrometry dan MRI sebagai acuan methods.8 , 9 Speckle pelacakan
memungkinkan untuk kuantifikasi cepat dan mudah ( < 1 menit ) , dengan reproduktifitas
lebih besar ( 7 % intraobserver variabilitas dalam kami pengalaman) dari LVEF atau
fraksi pemendekan .
Selain itu, analisis LS global, juga dikenal sebagai pencitraan fungsi otomatis ,
memungkinkan eksplorasi patofisiologi miokard dengan cara baru , terutama dengan
mendeteksi perubahan awal dalam komponen longitudinal LV fungsi sistolik , sedangkan
komponen radial dianggap normal.10 - 12 ini temuan ini diamati dengan penuaan normal
maupun dengan prekursor khas gagal jantung dengan EF normal, seperti yang terlihat
pada hipertensi , diabetes , kardiomiopati hipertrofik , stenosis aorta berat , dan
ischemia.10 - 15 pada pasien hipertensi , dan fibrosis interstisial perivaskular adalah
cenderung mempengaruhi terutama subendokardium tersebut . Serat longitudinal ,
sebagai konsekuensi dari lokasi subendocardial terkemuka mereka, lebih rentan terhadap
fibrosis dan kelebihan hemodinamik . Dengan demikian , fungsi subendocardial panjang
sumbu mungkin terganggu lama sebelum disfungsi serat melingkar berkembang di
midwall atau disfungsi serat radial di lapisan subepicardial . Akibatnya, subendocardial
fungsi panjang sumbu dipandang sebagai penanda potensi subklinis LV disfungsi dalam
beberapa penyakit conditions.13 , 14 Demikian pula , serat memanjang lebih rentan
terhadap iskemia dari serat radial . Dengan demikian , tampaknya ada seluruh spektrum
kelainan fungsi sistolik , mulai dari fungsi jantung sistolik normal gagal jantung sistolik ,
dengan gagal jantung dengan EF yang normal yang terletak di antara .
Pengaruh Alkohol Kemabukan Akut pada LV Fungsi
Dalam studi pada hewan dan subyek sehat , alkohol keracunan terbukti menyebabkan
penurunan dosis-tergantung dari kontraktilitas jantung , 5,6 dengan respon inflamasi
sistemik yang dianggap sebagai salah satu yang mendasari patofisiologi mechanisms.16
Etanol dapat mengubah aktivasi sel dengan interaksi tertentu dengan molekul membran
sel , sehingga melibatkan bawaan system.16 kekebalan tubuh
Beberapa penelitian yang diterbitkan melaporkan depresi di LV kontraktilitas setelah
konsumsi etanol akut didasarkan pada pendekatan hemodinamik invasif , 1 sistolik
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evaluasi interval waktu ( periode preejection / LV waktu ejeksi ) , 2,3 atau EF dengan
echocardiography.4
Delgado et al . meneliti efek dari dosis oral wiski pada fungsi LV dalam kelompok
sukarelawan normal ( n = 13 ) .4 Pada 30 menit setelah menelan alkohol , denyut jantung
meningkat sebesar 11 % , sedangkan perubahan fraksional di sumbu minor dari LV
mengalami penurunan sebesar 6 % dan LVEF sebesar 4% ( P < 0,001 ) . Hasil ini ,
bagaimanapun, harus ditafsirkan dengan hati-hati , mengingat ukuran sampel yang kecil
dan mengingat bahwa pengukuran LVEF menunjukkan variabilitas 10-15 % , terutama
ketika menggunakan sistem echocardiographic dari pertengahan 1970-an . Sebaliknya ,
variabilitas pengukuran LS global yang diperkirakan 7 % , karena berdasarkan
pengalaman kita sendiri .
Baru-baru ini , sebuah studi klinis MRI dilaporkan cedera miokard reversibel seperti
yang didefinisikan oleh hyperhancement miokard setelah pesta minuman keras , tetapi
tanpa penurunan seiring LV sistolik function.7This studi terakhir menunjukkan bahwa
alkohol tidak berpengaruh signifikan terhadap LVEF setelah keracunan alkohol akut , di
sejalan dengan pengamatan kami sendiri . Akibatnya , fungsi radial dapat dipertahankan
dalam tahap awal , sedangkan komponen memanjang mungkin bisa diubah pada tahap
awal , yang terutama dicatat dengan radius lebih dari kelengkungan serat memanjang
dibandingkan dengan serat radial (hukum Laplace ) . Karena semakin besar
kelengkungan radius , para myofibers memanjang dianggap lebih rentan terhadap
fenomena yang berbeda mengubah LV kontraktilitas dibandingkan dengan serat radial .
keterbatasan
LVEF dievaluasi dalam 2D menggunakan metode biplan Simpson , meskipun volumenya
3D kuantifikasi mungkin lebih akurat untuk mengukur EF dan volume . Karena hanya
subjek laki-laki dilibatkan dalam penelitian kami, efek dari alkohol keracunan pada LV
fungsi sistolik pada wanita tidak dinilai. Dalam studi ini , kami tidak melakukan
echocardiography serial pada mata pelajaran mabuk alkohol. Ini harus telah memperkuat
hasil kami .
Preload dan afterload modifikasi mungkin menyebabkan dampak pada strain LV . Dalam
stenosis aorta berat atau cardiopathy hipertensi , elevasi afterload ditunjukkan untuk
mempengaruhi lebih spesifik komponen longitudinal LV fungsi sistolik , karena radius
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lebih dari kelengkungan serat longitudinal. Segera setelah alkohol keracunan pada
subyek sehat , tekanan darah , denyut jantung , dan volume yang ditampilkan untuk
ditingkatkan . Karena itu, kami mengasumsikan bahwa preload dan afterload ketinggian
mungkin berdampak pada LS global. Namun, analisis regresi multivariat menunjukkan
bahwa kadar alkohol dalam darah sendiri secara signifikan terkait dengan LS global,
sedangkan tekanan darah , denyut jantung , LVEF , dan LV volume tidak .
kesimpulan
LS global dengan bintik echocardiography pelacakan memungkinkan untuk deteksi yang
lebih akurat dari awal LV sistolik disfungsi setelah meriah keracunan alkohol
dibandingkan dengan LVEF , dengan hasil yang independen dari tekanan darah , denyut
jantung , dan LV volume variasi .
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