运用斑点追踪超声心动图检测重症哮喘患者的心力衰竭
2025/08/31
摘要
背景：旨在确定哮喘持续状态患者是否存在急性心肌功能障碍。
方法：自2006年至2025年，本研究纳入重症哮喘患者、健康对照人群及进行卧推举重的举重运动员。采用速度向量成像（VVI）斑点追踪超声心动图技术评估组间差异，并对哮喘患者进行了为期6个月的随访。
结果：在357名参与者中，169人为对照组。哮喘患者（n=188）中位年龄为58.11±12.97岁，与对照组具有可比性。其中31例患者死亡。所有重症哮喘患者均表现出双心室应变降低。卧推运动后，举重运动员的所有超声心动图测量值均高于非运动员组及哮喘患者组。急性哮喘患者表现为四个心腔应变均低于对照组，且更易出现不同步运动。右心室整体纵向应变分别为：对照组[-27.56±4.56]、举重运动员基础值组[-24.08±1.23]、卧推后组[-30.88±1.02]及重症哮喘组[-17.98±2.57]（p值=0.0001）；左心室整体纵向应变（%）分别为：-21.02±3.28、-19.34±3.78、-25.21±9.32、-14.88±1.27（p值=0.012）。多变量分析显示，右心房泵应变（OR 0.457 [0.189-0.746]）与死亡率独立相关。机械通气与右心室整体纵向应变（OR 0.637，95%CI [0.248-0.925]）及右心房泵应变（OR 0.783，95%CI [0.349-0.967]）存在关联。在6个月随访时，哮喘患者所有心腔的变形参数及斑点追踪矢量速度分析结果均较对照组降低。
结论：急性哮喘患者表现为全心腔应变降低，且在六个月随访时仍持续存在。哮喘可能导致潜在的心力衰竭。
Detecting heart failure in severe asthma patients using speckle tracking echocardiography.
Javier, Hidalgo-Martín; María,
Abstrast
BACKGROUND: To determine the presence of acute myocardial dysfunction in status asthmaticus.
METHODOLOGY: From 2006 to 2025, we studied severe asthma patients, healthy controls, and weightlifters performing bench press. Group differences were evaluated using echocardiography with Speckle Tracking by velocity vector imaging (VVI). Asthma patients were followed for 6 months.
RESULTS: Of 357 participants, 169 were controls. The median age of asthmatic patients (n = 188) was 58.11 ± 12.97 years, comparable to controls. Thirty-one patients died. All patients with severe asthma demonstrated reduced biventricular strain. After bench press, all echocardiographic values were higher compared to non-sportsmen and asthmatic patients. Acute asthma patients demonstrated lower strain in the four cavities, and more asynchrony versus controls. Right ventricular global longitudinal strain was ([- 27.56 ± 4.56] in the control group, [- 24.08 ± 1.23] in the basal weightlifters' group, [- 30.88 ± 1.02] after bench press and [- 17.98 ± 2.57] in severe asthma, p value = 0.0001). Left ventricular global longitudinal strain (%) were (- 21.02 ± 3.28, - 19.34 ± 3.78, - 25.21 ± 9.32, - 14.88 ± 1.27, p value = 0.012) respectively. Multivariate analysis identified right atrial pump strain (OR 0.457 [0.189-0.746]) and as factors associated with mortality. Mechanical Ventilation was associated with RVGLS (OR 0.637, CI 95% [0.248-0.925]) and right atrial pump strain (OR 0.783, CI 95% [0.349-0.967]). At 6 months follow-up, asthmatic patients exhibited lower deformity parameters and decreased Speckle Tracking vectorial velocity analysis in all cardiac chambers compared to control groups.
CONCLUSION: Patients with acute asthma exhibit decreased strain in all cardiac chambers, which remains reduced at the six-month follow-up. Asthma may contribute to latent heart failure.
背景：旨在确定哮喘持续状态患者是否存在急性心肌功能障碍。
方法：自2006年至2025年，本研究纳入重症哮喘患者、健康对照人群及进行卧推举重的举重运动员。采用速度向量成像（VVI）斑点追踪超声心动图技术评估组间差异，并对哮喘患者进行了为期6个月的随访。
结果：在357名参与者中，169人为对照组。哮喘患者（n=188）中位年龄为58.11±12.97岁，与对照组具有可比性。其中31例患者死亡。所有重症哮喘患者均表现出双心室应变降低。卧推运动后，举重运动员的所有超声心动图测量值均高于非运动员组及哮喘患者组。急性哮喘患者表现为四个心腔应变均低于对照组，且更易出现不同步运动。右心室整体纵向应变分别为：对照组[-27.56±4.56]、举重运动员基础值组[-24.08±1.23]、卧推后组[-30.88±1.02]及重症哮喘组[-17.98±2.57]（p值=0.0001）；左心室整体纵向应变（%）分别为：-21.02±3.28、-19.34±3.78、-25.21±9.32、-14.88±1.27（p值=0.012）。多变量分析显示，右心房泵应变（OR 0.457 [0.189-0.746]）与死亡率独立相关。机械通气与右心室整体纵向应变（OR 0.637，95%CI [0.248-0.925]）及右心房泵应变（OR 0.783，95%CI [0.349-0.967]）存在关联。在6个月随访时，哮喘患者所有心腔的变形参数及斑点追踪矢量速度分析结果均较对照组降低。
结论：急性哮喘患者表现为全心腔应变降低，且在六个月随访时仍持续存在。哮喘可能导致潜在的心力衰竭。
（中日友好医院呼吸与危重症医学科 万静萱 摘译 林江涛 审校）
（Crit Care 2025 Aug 21;29(1):374;DOI:10.1186/s13054-025-05587-1.IF:6.407）
Detecting heart failure in severe asthma patients using speckle tracking echocardiography.
Javier, Hidalgo-Martín; María,
Abstrast
BACKGROUND: To determine the presence of acute myocardial dysfunction in status asthmaticus.
METHODOLOGY: From 2006 to 2025, we studied severe asthma patients, healthy controls, and weightlifters performing bench press. Group differences were evaluated using echocardiography with Speckle Tracking by velocity vector imaging (VVI). Asthma patients were followed for 6 months.
RESULTS: Of 357 participants, 169 were controls. The median age of asthmatic patients (n = 188) was 58.11 ± 12.97 years, comparable to controls. Thirty-one patients died. All patients with severe asthma demonstrated reduced biventricular strain. After bench press, all echocardiographic values were higher compared to non-sportsmen and asthmatic patients. Acute asthma patients demonstrated lower strain in the four cavities, and more asynchrony versus controls. Right ventricular global longitudinal strain was ([- 27.56 ± 4.56] in the control group, [- 24.08 ± 1.23] in the basal weightlifters' group, [- 30.88 ± 1.02] after bench press and [- 17.98 ± 2.57] in severe asthma, p value = 0.0001). Left ventricular global longitudinal strain (%) were (- 21.02 ± 3.28, - 19.34 ± 3.78, - 25.21 ± 9.32, - 14.88 ± 1.27, p value = 0.012) respectively. Multivariate analysis identified right atrial pump strain (OR 0.457 [0.189-0.746]) and as factors associated with mortality. Mechanical Ventilation was associated with RVGLS (OR 0.637, CI 95% [0.248-0.925]) and right atrial pump strain (OR 0.783, CI 95% [0.349-0.967]). At 6 months follow-up, asthmatic patients exhibited lower deformity parameters and decreased Speckle Tracking vectorial velocity analysis in all cardiac chambers compared to control groups.
CONCLUSION: Patients with acute asthma exhibit decreased strain in all cardiac chambers, which remains reduced at the six-month follow-up. Asthma may contribute to latent heart failure.
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