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Сопоставление векторкардиографических параметров со структурно-функциональным состоянием правого желудочка у пациентов с легочной гипертензией
Сопоставление векторкардиографических параметров со структурно-функциональным состоянием правого желудочка у пациентов с легочной гипертензией
Блинова Е.В., Сахнова Т.А., Саидова М.А. и др. Сопоставление векторкардиографических параметров со структурно-функциональным состоянием правого желудочка у пациентов с легочной гипертензией. Системные гипертензии. 2015; 12 (4): 57–60.
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Аннотация
Изменения векторкардиографического желудочкового градиента (VG) у пациентов с легочной артериальной гипертензией (ЛАГ) являются показателем перегрузки правого желудочка (ПЖ) и могут использоваться для оценки ее тяжести. Целью исследования было оценить взаимосвязь векторкардиографических показателей VG и пространственный угол QRS-T с эхокардиографическими показателями структурно-функционального состояния ПЖ.
У 30 пациентов с ЛАГ были оценены размеры ПЖ; амплитуда экскурсии фиброзного кольца трикуспидального клапана (TAPSE), относительное изменение площади ПЖ (FAC), систолическая скорость ПЖ (TDI-S’); продольная деформация (LS). VG и пространственный угол QRS-T рассчитывали с использованием ортогональных отведений, синтезированных из стандартной электрокардиографии.
Пространственная компонента VG-Y имела умеренную отрицательную корреляцию с LS (r=-0,62; p<0,005); амплитуда VG и компоненты VG-Х и VG-Y – положительные корреляции с FAC (r от 0,50 до 0,65; р<0,005); амплитуда VG и компонента VG-Y – положительные корреляции с TDI-S’ (r 0,58 и 0,53; p<0,005), пространственный угол QRS-T – отрицательные корреляции с TAPSE (r=-0,59; p<0,005), FAC (r=-0,66; p<0,005) и TDI-S’ (r=-0,67); p<0,005.
У лиц с тяжелой ЛАГ VG и пространственный угол QRS-T коррелируют не только с размерами ПЖ и давлением в легочной артерии, но и с параметрами систолической функции ПЖ.
Ключевые слова: векторкардиография, желудочковый градиент, эхокардиография, систолическая функция правого желудочка.
The following parameters were assessed in 30 PAH patients: RV dimensions; tricuspid annular plane systolic excursion (TAPSE); RV fractional area change (FAC); RV peak systolic annular velocity (TDI-S’), and longitudinal strain (LS). VG and spatial QRS-T angle were calculated using the orthogonal leads derived from standard echocardiography.
Spatial component VG-Y had moderate negative correlation with LS (r=-0.62; p<0.005); VG magnitude, VG-X and VG-Y had positive correlations with FAC (r from 0.50 to 0.65; p<0.005); VG magnitude and VG-Y had positive correlations with TDI-S’ (0.58 and 0.53; p<0.005); spatial QRS-T angle had negative correlation with TAPSE (r=-0.59; p<0.005), FAC (r=-0.66; p<0.005) and TDI-S’ (r=-0.67); p<0.005.
In patients with severe PAH, VG and spatial QRS-T angle correlate not only with RV dimensions and pulmonary artery pressure, but with parameters of RV systolic function.
Key words: vectorcardiography, ventricular gradient, echocardiography, right ventricular systolic function.
У 30 пациентов с ЛАГ были оценены размеры ПЖ; амплитуда экскурсии фиброзного кольца трикуспидального клапана (TAPSE), относительное изменение площади ПЖ (FAC), систолическая скорость ПЖ (TDI-S’); продольная деформация (LS). VG и пространственный угол QRS-T рассчитывали с использованием ортогональных отведений, синтезированных из стандартной электрокардиографии.
Пространственная компонента VG-Y имела умеренную отрицательную корреляцию с LS (r=-0,62; p<0,005); амплитуда VG и компоненты VG-Х и VG-Y – положительные корреляции с FAC (r от 0,50 до 0,65; р<0,005); амплитуда VG и компонента VG-Y – положительные корреляции с TDI-S’ (r 0,58 и 0,53; p<0,005), пространственный угол QRS-T – отрицательные корреляции с TAPSE (r=-0,59; p<0,005), FAC (r=-0,66; p<0,005) и TDI-S’ (r=-0,67); p<0,005.
У лиц с тяжелой ЛАГ VG и пространственный угол QRS-T коррелируют не только с размерами ПЖ и давлением в легочной артерии, но и с параметрами систолической функции ПЖ.
Ключевые слова: векторкардиография, желудочковый градиент, эхокардиография, систолическая функция правого желудочка.
________________________________________________
The following parameters were assessed in 30 PAH patients: RV dimensions; tricuspid annular plane systolic excursion (TAPSE); RV fractional area change (FAC); RV peak systolic annular velocity (TDI-S’), and longitudinal strain (LS). VG and spatial QRS-T angle were calculated using the orthogonal leads derived from standard echocardiography.
Spatial component VG-Y had moderate negative correlation with LS (r=-0.62; p<0.005); VG magnitude, VG-X and VG-Y had positive correlations with FAC (r from 0.50 to 0.65; p<0.005); VG magnitude and VG-Y had positive correlations with TDI-S’ (0.58 and 0.53; p<0.005); spatial QRS-T angle had negative correlation with TAPSE (r=-0.59; p<0.005), FAC (r=-0.66; p<0.005) and TDI-S’ (r=-0.67); p<0.005.
In patients with severe PAH, VG and spatial QRS-T angle correlate not only with RV dimensions and pulmonary artery pressure, but with parameters of RV systolic function.
Key words: vectorcardiography, ventricular gradient, echocardiography, right ventricular systolic function.
Полный текст
Список литературы
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8. Rudski LG, Lai WW, Afilalo J et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010; 23 (7): 685–713.
9. Kors JA, Van Herpen G, Sittig AC, Van Bemmel JH. Reconstruction of the Frank vectorcardiogram from standard electrocardiographic leads: diagnostic comparison of different methods. Eur Heart J 1990; 11: 1083–92.
10. Scherptong RW, Henkens IR, Man SC et al. Normal limits of the spatial QRS-T angle and ventricular gradient in 12-lead electrocardiograms of young adults: dependence on sex and heart rate. J Electrocardiol 2008; 41 (6): 648–55.
11. Voulgari C, Pagoni S, Tesfaye S, Tentolouris N. The spatial QRS-T angle: implications in clinical practice. Curr Cardiol Rev 2013; 9 (3): 197–210.
12. Man S, Rahmattulla C, Maan AC et al. Role of the vectorcardiogram-derived spatial QRS-T angle in diagnosing left ventricular hypertrophy. J Electrocardiol 2012; 45 (2): 154–60.
13. Bacharova L, Estes H, Bang L et al. The first statement of the Working Group on Electrocardiographic Diagnosis of Left Ventricular Hypertrophy. J Electrocardiol 2010; 43 (3): 197–9.
14. Bacharova L, Estes EH, Bang LE et al. Second statement of the working group on electrocardiographic diagnosis of left ventricular hypertrophy. J Electrocardiol 2011; 44 (5): 568–70.
15. Jr. Estes EH. ECG manifestations of left ventricular electrical remodelling. J Electrocardiol 2012; 45 (6): 612–6.
16. Hill JA. Hypertrophic reprogramming of the left ventricle: translation to the ECG. J Electrocardiol 2012; 45 (6): 624–9.
17. Bacharova L. Left ventricular hypertrophy: disagreements between increased left ventricular mass and ECG-LVH criteria: the effect of impaired electrical properties of myocardium. J Electrocardiol 2014; 47 (5): 625–9.
18. Blyth KG, Kinsella J, Hakacova N et al. Quantitative estimation of right ventricular hypertrophy using ECG criteria in patients with pulmonary hypertension: A comparison with cardiac MRI. Pulm Circ 2011; 1 (4): 470–4.
19. Siddiqui AM, Samad Z, Hakacova N et al. The utility of modified Butler-Leggett criteria for right ventricular hypertrophy in detection of clinically significant shunt ratio in ostium secundum-type atrial septal defect in adults. J Electrocardiol 2010; 43 (2): 161–6.
20. Motoji Y, Tanaka H, Fukuda Y et al. Efficacy of right ventricular free-wall longitudinal speckle-tracking strain for predicting long-term outcome in patients with pulmonary hypertension. Circ J 2013; 77 (3): 756–63.
2. Vonk Noordegraaf A, Galiè N. The role of the right ventricle in pulmonary arterial hypertension. Eur Respir Rev 2011; 20 (122): 243–53.
3. Badano LP, Ginghina C, Easaw J et al. Right ventricle in pulmonary arterial hypertension: haemodynamics, structural changes, imaging, and proposal of a study protocol aimed to assess remodelling and treatment effects. Eur J Echocardiogr 2010; 11 (1): 27–37.
4. Macfarlane PW, Okin PM, Lawrie TDV, Milliken JA. Enlargement and Hypertrophy. In: P.W.Macfarlane, A.Van Oosterom, O.Pahlm, P.Kligfield, M.Janse, J.Camm, editors. Comprehensive electrocardiology. London: Springer Verlag; 2011; p. 607–44.
5. Henkens IR, Mouchaers KT, Vonk-Noordegraaf A et al. Improved ECG detection of presence and severity of right ventricular pressure load validated with cardiac magnetic resonance imaging. Am J Physiol Heart Circ Physiol 2008; 294 (5): H2150–H2157.
6. Kamphuis VP, Haeck ML, Wagner GS et al. Electrocardiographic detection of right ventricular pressure overload in patients with suspected pulmonary hypertension. J Electrocardiol 2014; 47 (2): 175–82.
7. Scherptong RW, Henkens IR, Kapel GF et al. Diagnosis and mortality prediction in pulmonary hypertension: the value of the electrocardiogram-derived ventricular gradient. J Electrocardiol 2012; 45(3): 312–8.
8. Rudski LG, Lai WW, Afilalo J et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010; 23 (7): 685–713.
9. Kors JA, Van Herpen G, Sittig AC, Van Bemmel JH. Reconstruction of the Frank vectorcardiogram from standard electrocardiographic leads: diagnostic comparison of different methods. Eur Heart J 1990; 11: 1083–92.
10. Scherptong RW, Henkens IR, Man SC et al. Normal limits of the spatial QRS-T angle and ventricular gradient in 12-lead electrocardiograms of young adults: dependence on sex and heart rate. J Electrocardiol 2008; 41 (6): 648–55.
11. Voulgari C, Pagoni S, Tesfaye S, Tentolouris N. The spatial QRS-T angle: implications in clinical practice. Curr Cardiol Rev 2013; 9 (3): 197–210.
12. Man S, Rahmattulla C, Maan AC et al. Role of the vectorcardiogram-derived spatial QRS-T angle in diagnosing left ventricular hypertrophy. J Electrocardiol 2012; 45 (2): 154–60.
13. Bacharova L, Estes H, Bang L et al. The first statement of the Working Group on Electrocardiographic Diagnosis of Left Ventricular Hypertrophy. J Electrocardiol 2010; 43 (3): 197–9.
14. Bacharova L, Estes EH, Bang LE et al. Second statement of the working group on electrocardiographic diagnosis of left ventricular hypertrophy. J Electrocardiol 2011; 44 (5): 568–70.
15. Jr. Estes EH. ECG manifestations of left ventricular electrical remodelling. J Electrocardiol 2012; 45 (6): 612–6.
16. Hill JA. Hypertrophic reprogramming of the left ventricle: translation to the ECG. J Electrocardiol 2012; 45 (6): 624–9.
17. Bacharova L. Left ventricular hypertrophy: disagreements between increased left ventricular mass and ECG-LVH criteria: the effect of impaired electrical properties of myocardium. J Electrocardiol 2014; 47 (5): 625–9.
18. Blyth KG, Kinsella J, Hakacova N et al. Quantitative estimation of right ventricular hypertrophy using ECG criteria in patients with pulmonary hypertension: A comparison with cardiac MRI. Pulm Circ 2011; 1 (4): 470–4.
19. Siddiqui AM, Samad Z, Hakacova N et al. The utility of modified Butler-Leggett criteria for right ventricular hypertrophy in detection of clinically significant shunt ratio in ostium secundum-type atrial septal defect in adults. J Electrocardiol 2010; 43 (2): 161–6.
20. Motoji Y, Tanaka H, Fukuda Y et al. Efficacy of right ventricular free-wall longitudinal speckle-tracking strain for predicting long-term outcome in patients with pulmonary hypertension. Circ J 2013; 77 (3): 756–63.
2. Vonk Noordegraaf A, Galiè N. The role of the right ventricle in pulmonary arterial hypertension. Eur Respir Rev 2011; 20 (122): 243–53.
3. Badano LP, Ginghina C, Easaw J et al. Right ventricle in pulmonary arterial hypertension: haemodynamics, structural changes, imaging, and proposal of a study protocol aimed to assess remodelling and treatment effects. Eur J Echocardiogr 2010; 11 (1): 27–37.
4. Macfarlane PW, Okin PM, Lawrie TDV, Milliken JA. Enlargement and Hypertrophy. In: P.W.Macfarlane, A.Van Oosterom, O.Pahlm, P.Kligfield, M.Janse, J.Camm, editors. Comprehensive electrocardiology. London: Springer Verlag; 2011; p. 607–44.
5. Henkens IR, Mouchaers KT, Vonk-Noordegraaf A et al. Improved ECG detection of presence and severity of right ventricular pressure load validated with cardiac magnetic resonance imaging. Am J Physiol Heart Circ Physiol 2008; 294 (5): H2150–H2157.
6. Kamphuis VP, Haeck ML, Wagner GS et al. Electrocardiographic detection of right ventricular pressure overload in patients with suspected pulmonary hypertension. J Electrocardiol 2014; 47 (2): 175–82.
7. Scherptong RW, Henkens IR, Kapel GF et al. Diagnosis and mortality prediction in pulmonary hypertension: the value of the electrocardiogram-derived ventricular gradient. J Electrocardiol 2012; 45(3): 312–8.
8. Rudski LG, Lai WW, Afilalo J et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010; 23 (7): 685–713.
9. Kors JA, Van Herpen G, Sittig AC, Van Bemmel JH. Reconstruction of the Frank vectorcardiogram from standard electrocardiographic leads: diagnostic comparison of different methods. Eur Heart J 1990; 11: 1083–92.
10. Scherptong RW, Henkens IR, Man SC et al. Normal limits of the spatial QRS-T angle and ventricular gradient in 12-lead electrocardiograms of young adults: dependence on sex and heart rate. J Electrocardiol 2008; 41 (6): 648–55.
11. Voulgari C, Pagoni S, Tesfaye S, Tentolouris N. The spatial QRS-T angle: implications in clinical practice. Curr Cardiol Rev 2013; 9 (3): 197–210.
12. Man S, Rahmattulla C, Maan AC et al. Role of the vectorcardiogram-derived spatial QRS-T angle in diagnosing left ventricular hypertrophy. J Electrocardiol 2012; 45 (2): 154–60.
13. Bacharova L, Estes H, Bang L et al. The first statement of the Working Group on Electrocardiographic Diagnosis of Left Ventricular Hypertrophy. J Electrocardiol 2010; 43 (3): 197–9.
14. Bacharova L, Estes EH, Bang LE et al. Second statement of the working group on electrocardiographic diagnosis of left ventricular hypertrophy. J Electrocardiol 2011; 44 (5): 568–70.
15. Jr. Estes EH. ECG manifestations of left ventricular electrical remodelling. J Electrocardiol 2012; 45 (6): 612–6.
16. Hill JA. Hypertrophic reprogramming of the left ventricle: translation to the ECG. J Electrocardiol 2012; 45 (6): 624–9.
17. Bacharova L. Left ventricular hypertrophy: disagreements between increased left ventricular mass and ECG-LVH criteria: the effect of impaired electrical properties of myocardium. J Electrocardiol 2014; 47 (5): 625–9.
18. Blyth KG, Kinsella J, Hakacova N et al. Quantitative estimation of right ventricular hypertrophy using ECG criteria in patients with pulmonary hypertension: A comparison with cardiac MRI. Pulm Circ 2011; 1 (4): 470–4.
19. Siddiqui AM, Samad Z, Hakacova N et al. The utility of modified Butler-Leggett criteria for right ventricular hypertrophy in detection of clinically significant shunt ratio in ostium secundum-type atrial septal defect in adults. J Electrocardiol 2010; 43 (2): 161–6.
20. Motoji Y, Tanaka H, Fukuda Y et al. Efficacy of right ventricular free-wall longitudinal speckle-tracking strain for predicting long-term outcome in patients with pulmonary hypertension. Circ J 2013; 77 (3): 756–63.
________________________________________________
2. Vonk Noordegraaf A, Galiè N. The role of the right ventricle in pulmonary arterial hypertension. Eur Respir Rev 2011; 20 (122): 243–53.
3. Badano LP, Ginghina C, Easaw J et al. Right ventricle in pulmonary arterial hypertension: haemodynamics, structural changes, imaging, and proposal of a study protocol aimed to assess remodelling and treatment effects. Eur J Echocardiogr 2010; 11 (1): 27–37.
4. Macfarlane PW, Okin PM, Lawrie TDV, Milliken JA. Enlargement and Hypertrophy. In: P.W.Macfarlane, A.Van Oosterom, O.Pahlm, P.Kligfield, M.Janse, J.Camm, editors. Comprehensive electrocardiology. London: Springer Verlag; 2011; p. 607–44.
5. Henkens IR, Mouchaers KT, Vonk-Noordegraaf A et al. Improved ECG detection of presence and severity of right ventricular pressure load validated with cardiac magnetic resonance imaging. Am J Physiol Heart Circ Physiol 2008; 294 (5): H2150–H2157.
6. Kamphuis VP, Haeck ML, Wagner GS et al. Electrocardiographic detection of right ventricular pressure overload in patients with suspected pulmonary hypertension. J Electrocardiol 2014; 47 (2): 175–82.
7. Scherptong RW, Henkens IR, Kapel GF et al. Diagnosis and mortality prediction in pulmonary hypertension: the value of the electrocardiogram-derived ventricular gradient. J Electrocardiol 2012; 45(3): 312–8.
8. Rudski LG, Lai WW, Afilalo J et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010; 23 (7): 685–713.
9. Kors JA, Van Herpen G, Sittig AC, Van Bemmel JH. Reconstruction of the Frank vectorcardiogram from standard electrocardiographic leads: diagnostic comparison of different methods. Eur Heart J 1990; 11: 1083–92.
10. Scherptong RW, Henkens IR, Man SC et al. Normal limits of the spatial QRS-T angle and ventricular gradient in 12-lead electrocardiograms of young adults: dependence on sex and heart rate. J Electrocardiol 2008; 41 (6): 648–55.
11. Voulgari C, Pagoni S, Tesfaye S, Tentolouris N. The spatial QRS-T angle: implications in clinical practice. Curr Cardiol Rev 2013; 9 (3): 197–210.
12. Man S, Rahmattulla C, Maan AC et al. Role of the vectorcardiogram-derived spatial QRS-T angle in diagnosing left ventricular hypertrophy. J Electrocardiol 2012; 45 (2): 154–60.
13. Bacharova L, Estes H, Bang L et al. The first statement of the Working Group on Electrocardiographic Diagnosis of Left Ventricular Hypertrophy. J Electrocardiol 2010; 43 (3): 197–9.
14. Bacharova L, Estes EH, Bang LE et al. Second statement of the working group on electrocardiographic diagnosis of left ventricular hypertrophy. J Electrocardiol 2011; 44 (5): 568–70.
15. Jr. Estes EH. ECG manifestations of left ventricular electrical remodelling. J Electrocardiol 2012; 45 (6): 612–6.
16. Hill JA. Hypertrophic reprogramming of the left ventricle: translation to the ECG. J Electrocardiol 2012; 45 (6): 624–9.
17. Bacharova L. Left ventricular hypertrophy: disagreements between increased left ventricular mass and ECG-LVH criteria: the effect of impaired electrical properties of myocardium. J Electrocardiol 2014; 47 (5): 625–9.
18. Blyth KG, Kinsella J, Hakacova N et al. Quantitative estimation of right ventricular hypertrophy using ECG criteria in patients with pulmonary hypertension: A comparison with cardiac MRI. Pulm Circ 2011; 1 (4): 470–4.
19. Siddiqui AM, Samad Z, Hakacova N et al. The utility of modified Butler-Leggett criteria for right ventricular hypertrophy in detection of clinically significant shunt ratio in ostium secundum-type atrial septal defect in adults. J Electrocardiol 2010; 43 (2): 161–6.
20. Motoji Y, Tanaka H, Fukuda Y et al. Efficacy of right ventricular free-wall longitudinal speckle-tracking strain for predicting long-term outcome in patients with pulmonary hypertension. Circ J 2013; 77 (3): 756–63.
Авторы
Е.В.Блинова1, Т.А.Сахнова1, М.А.Саидова1, А.С.Лоскутова1, Г.В.Рябыкина1, О.А.Архипова1, Т.В.Мартынюк*1, В.Г.Трунов2, Э.А.Айду2, И.Е.Чазова1
1 ФГБУ Российский кардиологический научно-производственный комплекс Минздрава России. 121552, Россия, Москва, ул. 3-я Черепковская, д. 15а;
2 ФГБУН Институт проблем передачи информации им. А.А.Харкевича РАН. 127051, Россия, Москва, Большой Каретный пер., д. 19, стр. 1
*trukhiniv@mail.ru
1 Russian Cardiological Scientific-Industrial Complex of the Ministry of Health of the Russian Federation. 121552, Russian Federation, Moscow, 3-ia Cherepkovskaia, d. 15a;
2 А.A.Kharkevich Institute for Information Transmission Problems of RAS. 127051, Russian Federation, Moscow, Bol'shoi Karetnyi per., d. 19, str. 1
*trukhiniv@mail.ru
1 ФГБУ Российский кардиологический научно-производственный комплекс Минздрава России. 121552, Россия, Москва, ул. 3-я Черепковская, д. 15а;
2 ФГБУН Институт проблем передачи информации им. А.А.Харкевича РАН. 127051, Россия, Москва, Большой Каретный пер., д. 19, стр. 1
*trukhiniv@mail.ru
________________________________________________
1 Russian Cardiological Scientific-Industrial Complex of the Ministry of Health of the Russian Federation. 121552, Russian Federation, Moscow, 3-ia Cherepkovskaia, d. 15a;
2 А.A.Kharkevich Institute for Information Transmission Problems of RAS. 127051, Russian Federation, Moscow, Bol'shoi Karetnyi per., d. 19, str. 1
*trukhiniv@mail.ru
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