系统性红斑狼疮患者早期应用心超诊断全新及左心功能舒张功能不全的研究

   背景
   心血管事件是最常见的导致系统性红斑狼疮(SLE)患者死亡的独立原因。据报道,系统性红斑狼疮患者左心室射血分数升高或降低,充盈受损,左室增大已经有报道。然而,在既往研究中系统性红斑狼疮患者区域舒张功能还没有被准确评估,但左室功能障碍已被证明,这之前的左室收缩功能的恶化。因此,本研究的目的是通过非侵入性的检测方法来比较系统性红斑狼疮患者和正常人群的全心和的左心室舒张功能。
   方法
   共有104名从2004年和2007年之间的教学医院风湿病门诊就医的系统性红斑狼疮女性患者入组。所有患者均符合1997年美国风湿病学会修订的诊断标准。他们符合104项在照组年龄,性别的标准。所有患者左室射血分数都大于50%以上。排除标准包括怀孕,有心衰病史或有心衰症状,缺血性心脏疾病,心脏瓣膜病,心律失常。根据美国超声心动图指南的建议,常规超声心动图参数进行了测量。肺动脉收缩压(PASP)通过多普勒超声心动图的的收缩压进行测量,使用简化的伯努利方程,并增加估计右心房压力的基础上,下腔静脉随着呼吸变化进行评估。左室舒张功能的,104例SLE患者中的25例随机纳入年龄和性别匹配的组。测量4和2室心尖方法和胸骨旁短轴方法通过应用组织多普勒应变率来获得。
   结果
   身体质量指数(BMI,P =0.359),收缩压(SBP,P= 0.232),舒张压(DBP,磷= 0.572),脉压(PP,P= 0.121)和心率(HR,P = 0.683),在这两个组中大致相同。SLE组在E / E',左心房容积指数(LAVI),左室容积指数(LVMI)比对照组要高。 (图1-3),另外SLE组表现出显着较高的聚天冬氨酸和右心室舒张尺寸(16.61±3.85比18.83±4.83,P <0.001)。通过应变率的分析,SLE组表现明显比对照组高。
   结论
   除了收缩功能正常和无症状患者,有全心和区域性左室舒张功能减退的系统性红斑狼疮患者临床症状不典型,因此需要提出亚临床舒张功能不全的概念。系统性红斑狼疮患者的全心和区域性左室舒张功能减退可以行二维超声心动图和组织多普勒应变率来进行诊断。。
英文原文:
Usefulness Of Echocardiography In Early Detection Of Global And Regional Left Ventricular Diastolic Dysfunction In Systemic Lupus Erythematosus
   Background
   Cardiovascular events are the most common single cause of death in systemic lupus erythematosus(SLE). Increased and subnormal left ventricular (LV) ejection fractions, impaired diastolic filling and increased LV mass have been reported in SLE patients. However, regional diastolic function in SLE has not been evaluated properly in prior studies, and it has been demonstrated that this dysfunction precedes the deterioration of left ventricular systolic function. Therefore, the objective of the present study was to assess global and regional left ventricular diastolic function in SLE patients when compared to healthy individuals using appropriate non-invasive methods with diagnostic accuracy.
   Methods
   A total of 104 female SLE patients were enrolled from the rheumatology clinic of a teaching hospital between 2004 and 2007. All patients fulfilled the 1997 American College of Rheumatology revised diagnostic criteria. They were matched to 104 control subjects on the basis of age, gender. All the patients had a normal LVEF of above 50%. Exclusion criteria included pregnancy, those with history or symptoms of heart failure , ischemic heart disease, valvular heart disease, arrythmia. Conventional echocardiographic parameters were measured according to American Society of Echocardiography recommendations. Pulmonary arterial systolic pressure (PASP) was estimated by Doppler echocardiography from the systolic transtricuspid pressure gradient (in mm Hg), using the simplified Bernoulli equation and adding estimated right atrial pressure based on the size of the inferior vena cava and its variation with breathing. For regional left ventricular diastolic function, a 25 of 104 patients with SLE randomly enrolled and compared with 25 age-sex-matched controls. Stain rate of Tissue Doppler was obtained by the apical 4 and 2-chamber approach and parasternal short axis approach.
   Results
   Body mass index (BMI, P=0.359), systolic blood pressure (SBP, P=0.232), diastolic blood pressure (DBP, P=0.572), pulse pressure (PP, P=0.121) and heart rate (HR, P=0.683) were similar in both groups, which are shown in Table 1.SLE group demonstrated significantly higher E/E’, left atrial volume index (LAVI), LEFT ventricular mass index (LVMI) than the control group. (Figure 1-3) And, SLE group demonstrated significantly higher PASP (Figure 4) and right ventricular diastolic dimension (16.61±3.85 vs 18.83±4.83, P <0.001). In subgroup analysis for strain rate, SLE group demonstrated significantly higher than the control group. (Figure 5)
   Conclusions
   Despite normal systolic function and asymptomatic patients, disruption of global and regional left ventricular diastolic function in SLE is almost clinically silent, suggesting a subclinical diastolic dysfunction. Early detection of global and regional left ventricular diastolic dysfunction in SLE patients can be identified by two-dimensional echocardiography and stain rate of tissue Doppler.


    2012/4/1 17:21:53     访问数:450
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