RSS-Feed abonnieren
DOI: 10.1055/s-0029-1246069
© Georg Thieme Verlag KG Stuttgart · New York
Echokardiografische Gewebedoppleranalyse der Mitralringgeschwindigkeiten bei Patienten mit hypertropher Kardiomyopathie und bei Hochleistungssportlern
Echocardiographic Tissue Doppler Imaging Analysis of the Systolic and Early Diastolic Velocities of the Mitral Annulus Motion in Hypertrophic Cardiomyopathy and in Top-Level AthletesPublikationsverlauf
eingereicht: 10.7.2010
angenommen: 11.1.2011
Publikationsdatum:
03. Februar 2011 (online)
Zusammenfassung
Hintergrund und Fragestellung: Ziel dieser Studie war die gewebedopplerechokardiografische Analyse (Tissue Doppler Imaging, TDI) bei Patienten mit nicht obstruktiver hypertropher Kardiomyopathie (HNCM) und bei Leistungssportlern unter Verwendung der in der Literatur vorgeschlagenen Grenzwerte der systolischen (S′-) und frühdiastolischen (E′-)Geschwindigkeiten des Mitralringes (S′ < 9 cm/s, E′ < 9 cm/s) im Hinblick auf die Differenzierung zwischen pathologischen und physiologischen Formen der linksventrikulären Hypertrophie. Patienten und Methoden: Bei 17 Patienten mit HNCM und bei 80 Leistungssportlern wurde konsekutiv eine Analyse der S′- und E′-Geschwindigkeiten des septalen und lateralen Mitralringes mittels TDI durchgeführt. Ergebnisse: Die TDI-Analyse der systolischen Mitralringgeschwindigkeit S′ zeigte bei den HNCM-Patienten im Vergleich zu den Athleten signifikant niedrigerer Werte sowohl im Bereich des septalen Mitralringes (S′ septal: 5,1 ± 1,2 cm/s vs. 9,5 ± 1,5 cm/s, p < 0,001) als auch des lateralen Mitralringes (S′ lateral: 6,4 ± 2,0 cm/s vs. 10,5 ± 2,1 cm/s, p < 0,001). Auch die TDI-Analyse der frühdiastolischen Mitralringgeschwindigkeit E′ zeigte bei HNCM im Vergleich zu den Athleten signifikant niedrige Werte sowohl im Bereich des septalen Mitralringes (E′ septal: 5,9 ± 2,2 cm/s vs.13,1 ± 2,9 cm/s, p < 0,001) als auch des lateralen Mitralringes (E′ lateral: 8,2 ± 3,0 cm/s vs. 16,5 ± 3,4 cm/s, p < 0,001). Schlussfolgerungen: Die Gewebedoppleranalyse der systolischen und (früh-)diastolischen Mitralringbewegung (S′, E′) zeigt bei Patienten mit pathologischer Hypertrophie signifikant erniedrigte Werte und kann daher als sinnvolle Ergänzung im Rahmen der echokardiografischen Diagnostik zur Differenzierung zwischen pathologischen Hypertrophieformen (HNCM) und physiologischen, sportadaptiven Hypertrophieformen bei Leistungssportlern eingesetzt werden.
Abstract
Background and Objective: Echocardiographic Tissue Doppler Imaging (TDI) has been proposed for the differentiation of pathological left ventricular hypertrophy (e. g. hypertrophic cardiomyopathy, HCM) and physiologic left ventricular hypertrophy (athlete’s heart). The aim of this study was the TDI analysis of the systolic (S′) and early diastolic (E′) velocities in patients (pts.) with non-obstructive hypertrophic cardiomyopathy (HCM) and in top-level athletes in consideration of the previously published cut-off values (S′ < 9 cm/s, E′ < 9 cm/s). Patients and Methods: Pulsed-wave TDI of the systolic and early-diastolic velocities was performed at the lateral and septal mitral annulus in the four-chamber view in 17 HCM pts (12 men; mean age 44 ± 16 years) and 80 consecutive athletes (80 men; mean age 26 ± 5 years). Results: Pts with HCM showed significantly decreased systolic velocities of the septal (S′ septal: 5.1 ± 1.2 cm/s versus 9.5 ± 1.5 cm/s, p < 0.001) and lateral mitral annulus (S′ lateral: 6.4 ± 2.0 cm/s vs. 10.5 ± 2.1 cm/s, p < 0.001). The early diastolic velocity of the mitral annulus E′ was significantly decreased in HCM, too (E′ septal: 5.9 ± 2.2 cm/s vs. 13.1 ± 2.9 cm/s, p < 0.001; E′ lateral: 8.2 ± 3.0 cm/s vs. 16.5 ± 3.4 cm/s, p < 0.001). Conclusion: Tissue Doppler Imaging of the systolic and early diastolic velocity of the mitral annulus might be helpful as a promising additional method for the echocardiographic differentiation between pathological and physiologic left ventricular hypertrophy.
Key words
heart - echocardiography - ultrasound power Doppler - ultrasound spectral Doppler - athlete’s heart
Literatur
- 1 Barbier J, Ville N, Kervio G et al. Sports-Specific Features of Athlete’s Heart and their Relation to Echocardiographic Parameters. Herz. 2006; 31 531-543
- 2 Corrado D, Basso C, Schiavon M et al. Screening for hypertrophic cardiomyopathy in young athletes. N Engl J Med. 1998; 339 364-369
- 3 Corrado D, Basso C, Pavei A et al. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA. 2006; 296 1593-1601
- 4 Butz T, Buuren van F, Mellwig K P et al. Systolic and early diastolic left ventricular velocities assessed by tissue Doppler imaging in 100 top-level handball players. European Journal of Cardiovascular Prevention & Rehabilitation. 2010; 17 342-348
- 5 Faber L. Das „Sportherz“: Echokardiographische Differenzierung der sportadaptiven Hypertrophie von myokardialen Erkrankungen. Medizinische Welt. 2002; 53 427-431
- 6 Heinrich L, Schmid A, Vogt S et al. Die kardiale Voruntersuchung im Wettkampfsport. Herz. 2006; 31 514-518
- 7 Maron B J. Risk profiles and cardiovascular preparticipation screening of competitive athletes. Cardiol Clin. 1997; 15 473-483
- 8 Corrado D, Pelliccia A, Bjørnstad H H et al. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Eur Heart J. 2005; 26 516-524
- 9 Butz T, Faber L, Piper C et al. [Constrictive pericarditis or restrictive cardiomyopathy?. Echocardiographic tissue Doppler analysis] Deutsche Medizinische Wochenschrift. 2008; 133 399-405
- 10 Faber L, Lamp B, Hering D et al. Analysis of inter- and intraventricular asynchrony by tissue Doppler echocardiography. Z Kardiol. 2003; 92 994-1002
- 11 Butz T, Piper C, Langer C et al. Diagnostic superiority of a combined assessment of the systolic and early diastolic mitral annular velocities by tissue Doppler imaging for the differentiation of restrictive cardiomyopathy from constrictive pericarditis. Clin Res Cardiol. 2010; 99 207-215
- 12 Flachskampf F A, Breithardt O A, Daniel W G. Stellenwert des Gewebe-Dopplers in der Frühdiagnostik von Kardiomyopathien. Herz. 2007; 32 89-96
- 13 Ho C Y, Solomon S D. A clinician’s guide to Tissue Doppler Imaging. Circulation. 2006; 113 e396-e398
- 14 Ommen S R, Nishimura R A, Appleton C P et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: A comparative simultaneous Doppler-catheterization study. Circulation. 2000; 02 1788-1794
- 15 Vinereanu D, Florescu N, Sculthorpe N et al. Differentiation between pathologic and physiologic left ventricular hypertrophy by Tissue Doppler assessment of long-axis function in patients with Hypertrophic Cardiomyopathy or systemic hypertension and in athletes. American Journal of Cardiology. 2001; 88 53-58
- 16 Cardim N, Oliveira G, Longo S et al. Doppler Tissue Imaging: Regional Myocardial Function in Hypertrophic Cardiomyopathy and in Athlete’s Heart. J Am Soc Echocardiogr. 2003; 16 223-232
- 17 Claessens P JM, Claessens C WF, Claessens M MM et al. Supernormal left ventricular diastolic function in triathletes. Tex Heart Inst J. 2001; 28 102-120
- 18 D’Andrea A, D’Andrea L, Caso P et al. The usefulness of Doppler Myocardial Imaging in the study of Athlete’s Heart and in the differential diagnosis between physiological and pathological ventricular hypertrophy. Echocardiography. 2006; 23 149-157
- 19 King G, Foley J B, Royse C F et al. Myocardial stiffness and the timing difference between tissue Doppler imaging Ea and peak mitral valve opening can distinguish physiological hypertrophy in athletes from hypertrophic cardiomyopathy. Eur J Echocardiogr. 2006; 7 423-429
- 20 Pelà G, Bruschi G, Montagna L et al. Left and right ventricular adaptation assessed by Doppler tissue echocardiography in athletes. J Am Soc Echocardiogr. 2004; 17 205-211
- 21 Tumuklu M M, Ildizli M, Ceyhan K et al. Alterations in Left Ventricular Structure and Diastolic Function in Professional Football Players: Assessment by Tissue Doppler Imaging and Left Ventricular Flow Propagation Velocity. Echocardiography. 2007; 24 140-148
- 22 Zoncu S, Pelliccia A, Mercuro G. Assessment of regional systolic and diastolic wall motion velocities in highly trained athletes by pulsed wave Doppler Tissue Imaging. Journal of the American Society of Echocardiography. 2002; 15 900-905
- 23 Nagueh S F, Bachinski L L, Meyer D et al. Tissue Doppler Imaging consistently detects myocardial abnormalities in patients with hypertrophic cardiomyopathy and provides a novel means for an early diagnosis before and independently of hypertrophy. Circulation. 2001; 104 128-130
- 24 Nagueh S F, McFalls J, Meyer D et al. Tissue Doppler Imaging predicts the development of Hypertrophic Cardiomyopathy in Subjects with subclinical disease. Circulation. 2003; 108 395-398
- 25 Araujo A Q, Arteaga E, Ianni B M et al. Usefulness of a new proposed tissue Doppler imaging global function index in hypertrophic cardiomyopathy. Echocardiography. 2006; 23 197-201
- 26 Núñez J, Zamorano J L, Pérez De Isla L et al. Differences in regional systolic and diastolic function by Doppler tissue imaging in patients with hypertrophic cardiomyopathy and hypertrophy caused by hypertension. J Am Soc Echocardiogr. 2004; 17 717-722
- 27 Cheitlin M D, Armstrong W F, Aurigemma G P et al. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). Circulation. 2003; 108 1146-1162
- 28 Douglas P S, Khandheria B, Stainback R F et al. ACCF/ASE/ACEP/ASNC/SCAI/SCCT/SCMR 2007 appropriateness criteria for transthoracic and transesophageal echocardiography. J Am Coll Cardiol. 2007; 50 187-204
- 29 Gottdiener J S, Bednarz J, Devereux R et al. American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr. 2004; 17 1086-1119
- 30 Corrado D, Michieli P, Basso C et al. How to screen athletes for cardiovascular diseases. Cardiol Clin. 2007; 25 391-397
- 31 Kindermann W. Das Sportherz. Deutsche Zeitschrift für Sportmedizin. 2000; 51 307-308
- 32 Maron B J, Thompson P D, Ackerman M J et al. Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update. Circulation. 2007; 115 1643-1455
- 33 Dickhuth H H, Röcker K, Mayer F et al. Ausdauersport und kardiale Adaptation (Sportherz). Herz. 2004; 29 373-380
- 34 Scharhag J, Urhausen A, Schneider G et al. Reproducibility and clinical significance of exercise-induced increases in cardiac troponins and N-terminal pro brain natriuretic peptide in endurance athletes. Eur J Cardiovasc Prev Rehabil. 2006; 13 388-397
- 35 Maron B J, Pelliccia A. The Heart of Trained Athletes: Cardiac Remodelling and the Risks of Sports, Including Sudden Death. Circulation. 2006; 114 1633-1644
- 36 Caso P, D’Andrea A, Galderisi M et al. Pulsed Doppler Tissue Imaging in endurance athletes: Relation between left ventricular preload and myocardial diastolic function. American Journal of Cardiology. 2000; 85 1131-1136
- 37 Jungblut P R, Osborne J A, Quigg R J et al. Echocardiographic Doppler evaluation of left ventricular diastolic filling in older, highly trained male endurance athletes. Echocardiography. 2000; 17 7-16
- 38 Pelliccia A, Di Paolo F M, Corrado D et al. Evidence for efficacy of the Italian national pre-participation screening programme for identification of hypertrophic cardiomyopathy in competitive athletes. Eur Heart J. 2006; 27 2196-2200
- 39 Butz T, Langer C, Meissner A et al. Changes in the Velocities of the Mitral Annulus Assessed by Tissue Doppler Imaging with Respect to the Cardiac Rhythm. Ultraschall in Med. 2010; 31 415-416
- 40 Rawlins J, Bhan A, Sharma S. Left ventricular hypertrophy in athletes. Eur J Echocardiogr. 2009; 10 350-356
- 41 D’Andrea A, Cocchia R, Riegler L et al. Left ventricular myocardial velocities and deformation indexes in top-level athletes. J Am Soc Echocardiogr. 2010; 23 1281-1288
Dr. Thomas Butz
Cardiology and Angiology, Ruhr-University Bochum, Marienhospital Herne
Hoelkeskampring 30
44625 Herne
Telefon: ++ 49/23 23/49 90
Fax: ++ 49/23 23/49 93 60
eMail: Thomas.Butz@Marienhospital-Herne.de