Медицинская литература. Новинки

 

 

 

 

 

 

Расчет показателей миокардиальной работы левого желудочка при ультразвуковом исследовании сердца: методика, возможности, ограничения

Вы можете загрузить полный текст статьи в формате pdf

Данная статья посвящена оценке показателей миокардиальной работы левого желудочка (ЛЖ) с помощью методики построения кривых давление–деформация – новому инструменту в эхокардиографии, способному учесть влияние постнагрузки сердца на сократительную способность ЛЖ. Подробно изложены алгоритм действий по оценке миокардиальной работы, возможные трудности и особенности расчета ее основных показателей, обсуждены ограничения и недостатки методики. В статье приведены нормальные значения показателей миокардиальной работы ЛЖ, представлены их характерные изменения и преимущества использования при различных заболеваниях и патологических состояниях сердца.

Ключевые слова:
миокардиальная работа, кривая давление-деформация, speckle-tracking, эхокардиография, левый желудочек, myocardial work, pressure-strain loop, speckle-tracking, echocardiography, left ventricle

Литература:
1.Suga H. Total mechanical energy of a ventricle model and cardiac oxygen consumption. Am J Physiol–Hear Circ Physiol 1979; 236: H498-505.
2.Bastos MB, Burkhoff D, Maly J, Daemen J, den Uil CA, Ameloot K, Lenzen M, Mahfoud F, Zijlstra F, Schreuder JJ, Van Mieghem NM. Invasive left ventricle pressure-volume analysis: overview and practical clinical implications. Eur Heart J. 2020; 41: 1286–1297. https://doi.org/10.1093/eurheartj/ehz552.
3.Ilardi F, D'Andrea A, D'Ascenzi F, Bandera F, Benfari G, Esposito R, Malagoli A, Mandoli GE, Santoro C, Russo V, Crisci M, Esposito G, Cameli M, On Behalf Of The Working Group Of Echocardiography Of The Italian Society Of Cardiology Sic. Myocardial work by echocardiography: principles and applications in clinical practice. J Clin Med. 2021; 10: 4521. https://doi.org/10.3390/jcm10194521.
4.Moya A, Buytaert D, Penicka M, Bartunek J, Vanderheyden M. State-of-the-Art: Noninvasive Assessment of Left Ventricular Function Through Myocardial Work. J Am Soc Echocardiogr. 2023 Oct; 36(10): 1027-1042. https://doi.org/10.1016/j.echo.2023.07.002.
5.Russell K, Eriksen M, Aaberge L, Wilhelmsen N, Skulstad H, Remme EW, Haugaa KH, Opdahl A, Fjeld JG, Gjesdal O, Edvardsen T, Smiseth OA. A novel clinical method for quantification of regional left ventricular pressure-strain loop area: a non-invasive index of myocardial work. Eur Heart J. 2012 Mar; 33(6): 724-33. https://doi.org/10.1093/eurheartj/ehs016.
6.Russell K, Eriksen M, Aaberge L, Wilhelmsen N, Skulstad H, Gjesdal O, Edvardsen T, Smiseth OA. Assessment of wasted myocardial work: a novel method to quantify energy loss due to uncoordinated left ventricular contractions. American Journal of Physiology-Heart and Circulatory Physiology. 2013; 305(7): H996–1003. https://doi.org/10.1152/ajpheart.00191.2013.
7.Papadopoulos K, Ozden Tok O, Mitrousi K, Ikonomidis I. Myocardial Work: Methodology and Clinical Applications. Diagnostics (Basel). 2021 Mar 22; 11(3): 573. https://doi.org/10.3390/diagnostics11030573.
8.Smiseth OA, Donal E, Penicka M, Sletten OJ. How to measure left ventricular myocardial work by pressure-strain loops. Eur Heart J Cardiovasc Imaging. 2021 Feb 22; 22(3): 259-261. https://doi.org/10.1093/ehjci/jeaa301.
9.Иванов С.И., Алёхин М.Н. Неинвазивные показатели работы миокарда в оценке систолической функции левого желудочка. Кардиология. 2020; 60(3): 80-88. https://doi.org/10.18087/cardio.2020.3.n925. Ivanov SI, Alekhin MN. Myocardial work in assessment of left ventricular systolic function. Kardiologiia. 2020 Mar 18; 60(3): 80-88. https://doi.org/10.18087/cardio.2020.3.n925. (In Russian)
10.Collier P, Phelan D, Klein A. A Test in Context: Myocardial Strain Measured by Speckle-Tracking Echocardiography. J Am Coll Cardiol. 2017 Feb 28; 69(8): 1043-1056. https://doi.org/10.1016/j.jacc.2016.12.012.
11.Marzlin N, Hays AG, Peters M, Kaminski A, Roemer S, O'Leary P, Kroboth S, Harland DR, Khandheria BK, Tajik AJ, Jain R. Myocardial Work in Echocardiography. Circ Cardiovasc Imaging. 2023 Feb; 16(2): e014419. https://doi.org/10.1161/CIRCIMAGING.122.014419.
12.Manganaro R, Marchetta S, Dulgheru R, Ilardi F, Sugimoto T, Robinet S, Cimino S, Go YY, Bernard A, Kacharava G, Athanassopoulos GD, Barone D, Baroni M, Cardim N, Hagendorff A, Hristova K, Lopez-Fernandez T, de la Morena G, Popescu BA, Penicka M, Ozyigit T, Rodrigo Carbonero JD, van de Veire N, Von Bardeleben RS, Vinereanu D, Zamorano JL, Rosca M, Calin A, Moonen M, Magne J, Cosyns B, Galli E, Donal E, Carerj S, Zito C, Santoro C, Galderisi M, Badano LP, Lang RM, Oury C, Lancellotti P. Echocardiographic reference ranges for normal non-invasive myocardial work indices: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging. 2019 May 1; 20(5): 582-590. https://doi.org/10.1093/ehjci/jey188.
13.Truong VT, Vo HQ, Ngo TNM, Mazur J, Nguyen TTH, Pham TTM, Le TK, Phan H, Palmer C, Nagueh SF, Chung ES. Normal Ranges of Global Left Ventricular Myocardial Work Indices in Adults: A Meta-Analysis. J Am Soc Echocardiogr. 2022 Apr; 35(4): 369-377.e8. https://doi.org/10.1016/j.echo.2021.11.010.
14.Olsen FJ, Skaarup KG, Lassen MCH, Johansen ND, Sengelov M, Jensen GB, Schnohr P, Marott JL, Sogaard P, Gislason G, Svendsen JH, Mogelvang R, Aalen JM, Remme EW, Smiseth OA, Biering-Sorensen T. Normal Values for Myocardial Work Indices Derived From Pressure-Strain Loop Analyses: From the CCHS. Circ Cardiovasc Imaging. 2022 May; 15(5): e013712. https://doi.org/10.1161/CIRCIMAGING.121.013712.
15.Chan J, Edwards NFA, Scalia GM, Khandheria BK. Myocardial Work: A New Type of Strain Imaging? J Am Soc Echocardiogr. 2020 Jun 23; S0894-7317(20) 30295-9. https://doi.org/10.1016/j.echo.2020.05.004.
16.Dobrovie M, Bezy S, Unlu S, Chakraborty B, Petrescu A, Duchenne J, Beela AS, Voigt JU. How Does Regional Hypertrophy Affect Strain Measurements With Different Speckle-Tracking Methods? J Am Soc Echocardiogr. 2019 Nov; 32(11): 1444-1450. https://doi.org/10.1016/j.echo.2019.06.008.
17.Tokodi M, Olah A, Fabian A, Lakatos BK, Hizoh I, Ruppert M, Sayour AA, Barta BA, Kiss O, Sydo N, Csulak E, Ladanyi Z, Merkely B, Kovacs A, Radovits T. Novel insights into the athlete's heart: is myocardial work the new champion of systolic function? Eur Heart J Cardiovasc Imaging. 2022 Jan 24; 23(2): 188-197. https://doi.org/10.1093/ehjci/jeab162.
18.Chan J, Edwards NFA, Khandheria BK, Shiino K, Sabapathy S, Anderson B, Chamberlain R, Scalia GM. A new approach to assess myocardial work by non-invasive left ventricular pressure—strain relations in hypertension and dilated cardiomyopathy. Eur Heart J Cardiovasc Imaging. 2019 Jan 1; 20(1): 31-39. https://doi.org/10.1093/ehjci/jey131.
19.Tadic M, Cuspidi C, Pencic B, Grassi G, Celic V. Myocardial work in hypertensive patients with and without diabetes: an echocardiographic study. J Clin Hypertens (Greenwich). 2020; 22: 2121–2127. https://doi.org/10.1111/jch.14053.
20.Jaglan A, Roemer S, Perez Moreno AC, Khandheria BK. Myocardial work in stage 1 and 2 hypertensive patients. Eur Heart J Cardiovasc Imaging. 2021; 22: 744–750. https://doi.org/10.1093/ehjci/jeab043.
21.Boe E, Russell K, Eek C, Eriksen M, Remme EW, Smiseth OA, Skulstad H. Non-invasive myocardial work index identifies acute coronary occlusion in patients with non-ST-segment elevation-acute coronary syndrome. Eur Heart J Cardiovasc Imaging. 2015; 16: 1247–1255. https://doi.org/10.1093/ehjci/jev078.
22.Edwards NFA, Scalia GM, Shiino K, Sabapathy S, Anderson B, Chamberlain R, Khandheria BK, Chan J. Global myocardial work is superior to global longitudinal strain to predict significant coronary artery disease in patients with normal left ventricular function and wall motion. J Am Soc Echocardiogr. 2019; 32: 947–957. https://doi.org/10.1016/j.echo.2019.02.014.
23.Borrie A, Goggin C, Ershad S, Robinson W, Sasse A. Noninvasive myocardial work index: characterizing the normal and ischemic response to exercise. J Am Soc Echocardiogr. 2020; 33: 1191–1200. https://doi.org/10.1016/j.echo.2020.05.003.
24.Vecera J, Penicka M, Eriksen M, Russell K, Bartunek J, Vanderheyden M, Smiseth OA. Wasted septal work in left ventricular dyssynchrony: a novel principle to predict response to cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging. 2016; 17: 624–632. https://doi.org/10.1093/ehjci/jew019.
25.Galli E, Vitel E, Schnell F, Le Rolle V, Hubert A, Lederlin M, Donal E. Myocardial constructive work is impaired in hypertrophic cardiomyopathy and predicts left ventricular fibrosis. Echocardiogr. 2019; 36: 74–82. https://doi.org/10.1111/echo.14210.
26.Goncalves AV, Rosa SA, Branco L, Galrinho A, Fiarresga A, Lopes LR, Thomas B, Baquero L, Carmo MM, Ferreira RC. Myocardial work is associated with significant left ventricular myocardial fibrosis in patients with hypertrophic cardiomyopathy. Int J Cardiovasc Imaging. 2021; 37: 2237–2244. https://doi.org/10.1007/s10554-021-02186-3.
27.Hiemstra YL, van der Bijl P, El Mahdiui M, Bax JJ, Delgado V, Marsan NA. Myocardial work in nonobstructive hypertrophic cardiomyopathy: implications for outcome. J Am Soc Echocardiogr. 2020; 33: 1201–1208. https://doi.org/10.1016/j.echo.2020.05.010.
28.Clemmensen TS, Eiskj?r H, Ladefoged B, Mikkelsen F, Sorensen J, Granstam SO, Rosengren S, Flachskampf FA, Poulsen SH. Prognostic implications of left ventricular myocardial work indices in cardiac amyloidosis. Eur Heart J Cardiovasc Imaging. 2021; 22: 695–704. https://doi.org/10.1093/ehjci/jeaa097.
29.Cui C, Li Y, Liu Y, Huang D, Hu Y, Wang Y, Ma L, Liu L. Association between echocardiographic non-invasive myocardial work indices and myocardial fibrosis in patients with dilated cardiomyopathy. Front Cardiovasc Med. 2021; 8: 704251. https://doi.org/10.3389/fcvm.2021.704251.
30.Hedwig F, Nemchyna O, Stein J, Knosalla C, Merke N, Knebel F, Hagendorff A, Schoenrath F, Falk V, Knierim J. Myocardial work assessment for the prediction of prognosis in advanced heart failure. Front Cardiovasc Med. 2021; 8: 691611. https://doi.org/10.3389/fcvm.2021.691611.
31.Calvillo-Arguelles O, Thampinathan B, Somerset E, Shalmon T, Amir E, Steve Fan CP, Moon S, Abdel-Qadir H, Thevakumaran Y, Day J, Woo A, Wintersperger BJ, Marwick TH, Thavendiranathan P. Diagnostic and prognostic value of myocardial work indices for identification of cancer therapy-related cardiotoxicity. JACC Cardiovasc Imaging. 2022; 15: 1361–1376. https://doi.org/10.1016/j.jcmg.2022.02.027.
32.Ilardi F, Postolache A, Dulgheru R, Trung MN, de Marneffe N, Sugimoto T, Go YY, Oury C, Esposito G, Lancellotti P. Prognostic value of non-invasive global myocardial work in asymptomatic aortic stenosis. J Clin Med. 2022; 11: 1555. https://doi.org/10.3390/jcm11061555.
33.Meucci MC, Butcher SC, Galloo X, van der Velde ET, Marsan NA, Bax JJ, Delgado V. Noninvasive left ventricular myocardial work in patients with chronic aortic regurgitation and preserved left ventricular ejection fraction. J Am Soc Echocardiogr. 2022; 35: 703–711.e3. https://doi.org/10.1016/j.echo.2022.01.008.
34.Yedidya I, Lustosa RP, Fortuni F, van der Bijl P, Namazi F, Vo NM, Meucci MC, Ajmone Marsan N, Bax JJ, Delgado V. Prognostic implications of left ventricular myocardial work indices in patients with secondary mitral regurgitation. Circ Cardiovasc Imaging. 2021; 14: e012142. https://doi.org/10.1161/circimaging.120.012142.
35.Hubert A, Galli E, Leurent G, Corbineau H, Auriane B, Guillaume L, Leclercq C, Donal E. Left ventricular function after correction of mitral regurgitation: impact of the clipping approach. Echocardiogr. 2019; 36: 2010– 2018. https://doi.org/10.1111/echo.14523.
36.Minhas AS, Gilotra NA, Goerlich E, Metkus T, Garibaldi BT, Sharma G, Bavaro N, Phillip S, Michos ED, Hays AG. Myocardial work efficiency, a novel measure of myocardial dysfunction, Is reduced in COVID-19 patients and associated with in-hospital mortality. Front Cardiovasc Med. 2021; 8: 667721. https://doi.org/10.3389/fcvm.2021.667721.

The estimation of left ventricular myocardial work indicators during cardiac ultrasound imaging: methodology, capabilities, advantages and limitations

This article is dedicated to the assessment of left ventricular (LV) myocardial work indicators using the method of constructing pressure-strain loops, a new tool in echocardiography that can take into account the influence of cardiac afterload on LV contractility. The algorithm of actions for estimating myocardial work, possible difficulties and features of calculating its main indicators are described in detail, the limitations and disadvantages of the method are discussed. The normal ranges of LV myocardial work indicators are given in the article, and it presents their typical changes and the advantages of using in various diseases and pathological conditions of the heart.

Keywords:
миокардиальная работа, кривая давление-деформация, speckle-tracking, эхокардиография, левый желудочек, myocardial work, pressure-strain loop, speckle-tracking, echocardiography, left ventricle