chocardiography. 2012 September; 29(8): 927932. Published online 2012 May 29. doi: 10.1111/j.1540-8175.2012.01717.

x PMCID: PMC3465776

Early Detection of Left Ventricular Systolic Dysfunction Using Two-Dimensional Speckle Tracking Strain Evaluation in Healthy Subjects after Acute Alcohol Intoxication
Patricia Reant, M.D., Ph.D., Warren Chasseriaud, M.D., Xavier Pillois, Ph.D., Marina Dijos, M.D., Florence Arsac, M.D., Raymond Roudaut, M.D., and Stephane Lafitte, M.D., Ph.D. Author information Copyright and License information

Abstract Objectives: We evaluated the ability of two-dimensional speckle tracking strain echocardiography to detect left ventricular (LV) systolic dysfunction as compared with LV ejection fraction (EF) in healthy subjects following acute alcohol intoxication. Methods and Results: In total, 25 healthy subjects were investigated using echocardiography 46 hours after the onset of alcohol intoxication at a regional festive gathering, and then compared to 23 healthy control subjects without alcohol consumption. Heart rate, blood pressure, blood alcohol level, LV volumes, EF, shortening fraction, E/A ratio, as well as global longitudinal strain (LS) were recorded. Mean blood alcohol level was 1.3 0.3 g.L1. Mean systolic blood pressure and heart rate were slightly increased in the alcohol group compared to controls (147.5 21.8 mmHg vs 127.0 9.9 mmHg, P = 0.003, and 79.7 10.7 bpm vs 70.6 7.6 bpm, P < 0.001, respectively). While there was no significant difference in terms of LVEF (62.9 4.4% vs 64.8 5.9%, P = 0.18) or shortening fraction (34.7 5.9% vs 36.0 4.3%, P = 0.54), global LS was significantly impaired (17.8 2.0% vs 21.2 1.8%, P < 0.001). In addition, subjects who consumed alcohol had increased LV end-diastolic (108.3 20.1 mL vs 95.5 14.6 mL, P = 0.037) and end-systolic volumes (41.6 11.4 mL vs 33.7 6.9 mL, P = 0.024), along with depressed aortic time-velocity integral (19.9 3.2 mL vs 21.9 2.5 mL, P = 0.034). According to multivariate linear regression analyses, blood alcohol level was the only factor significantly associated with global LS (=3.6 1.0, P = 0.005). Conclusion: Alcohol intoxication around festive days induces acute LV contraction abnormalities, which may be detected using global LS by speckle tracking at an earlier stage and more accurately than LVEF decreases.

Keywords: binge intoxication

drinking,

speckle

tracking

strain

echocardiography,

alcohol

Previous studies have reported a depression in left ventricular (LV) contractility after acute ethanol consumption based on invasive hemodynamic approaches,1 systolic timeinterval evaluation (preejection period/LV ejection time),2,3 or ejection fraction (EF) by echocardiography.4 In studies on animals and healthy subjects, alcohol intoxication was shown to cause a dose-dependent impairment of cardiac contractility,5,6 with systemic inflammatory responses being considered as one of the pathophysiological mechanisms. A recent clinical magnetic resonance imaging (MRI) study reported a reversible myocardial injury with myocardial hyperenhancement after binge drinking, but without any decrease in LV systolic function.7 Myocardial deformation analysis using two-dimensional (2D) speckle tracking echocardiography has already been validated, showing high levels of reproducibility and accuracy in detecting subtle early LV systolic function abnormalities (depressed longitudinal deformation) in heart disorder patients without an altered EF.814 Therefore, our study aimed to investigate the ability of 2D speckle tracking strain echocardiography to detect early LV systolic dysfunction as compared with conventional LVEF evaluation in healthy subjects after acute alcohol intoxication versus a control group of healthy nonintoxicated subjects. Methods Study Protocol During a regional festive gathering, consecutive healthy men subjects admitted to the aid station were consecutively evaluated by the same observer using echocardiography, 3 to 4 hours after the onset of acute alcohol intoxication. A control group of volunteers, comprising medical students at our University Cardiologic Hospital, was recruited, given the condition that they had not consumed any alcohol for at least 10 days prior to the study. To be eligible as healthy subjects, subjects had to be free from any known cardiovascular disease, diabetes, and hypertension.

The study excluded subjects presenting insufficient ultrasound image quality, defined as more than three LV segments being suboptimally visualized by conventional echocardiography. Echocardiographic measurements were performed by a second observer, blinded to the subjects levels of alcohol consumption. Systolic and diastolic blood pressures, heart rate, and blood alcohol level were systematically measured immediately prior to the echocardiography. In order to estimate the blood alcohol levels, a portable breathalyzer approved by the National Authorities was used, with measurements being repeated three times and their mean values determined. Written informed consent was obtained from all subjects. In accordance with the local ethical guidelines, this observational study was designed to be performed in the context of popular festivities. Transthoracic Echocardiographic Data Acquisitions The subjects were examined in the left lateral decubitus position using a Vivid Q commercial ultrasound scanner (General Electric Healthcare, Haifa, Israel) with phasedarray transducers (M4S-RS). Thereafter, 2D data acquisitions were obtained, including parasternal long- and short-axis views and three standard apical views. For each view, three consecutive cardiac cycles were recorded during quiet respiration. Grey-scale recordings were optimized for LV evaluation at a mean frame rate of at least 50 sec1. Color Doppler recordings were obtained in order to exclude valvular dysfunction, and Doppler flow recordings were performed with a horizontal sweep velocity of 100 mm/sec. Echocardiographic Analysis All standard measurements were taken by the same observer using dedicated software (EchoPac PC, version BT11; General Electric Medical Systems, Horten, Norway), including percentage of LV fractional shortening, LV outflow tract time-velocity integral, peak velocity of E- and A- waves of the mitral inflow, as well as tissue Doppler analysis of max velocity E peak at the lateral mitral annulus. E/E ratio was calculated to
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represent LV end-diastolic pressure. Based on apical four- and two-chamber views, LV volumes and EF were measured according to Simpson's rule. All measurements were made by averaging three cardiac cycles. For longitudinal strain (LS) analysis, the software automatically tracked the contour on subsequent frames after three endocardial markers were placed in an end-diastolic frame. Adequate tracking could be verified in real time and corrected by adjusting the region of interest or manually correcting the contour so as to ensure optimal tracking. In addition, LS was assessed in apical views. Average LS was calculated for the 17 segments in relation to the strain magnitude at aortic valve closure. Longitudinal systolic deformation was characterized as shortening, and using the strain definition, systolic indices yielded a negative value. Reproducibility The second observer performed all the echocardiographic measurements, which were later repeated blindly for each parameter. The data were also analyzed by a third blinded observer for 10 of the subjects. Intraobserver reproducibility was calculated using the average difference between 10 measurements, and interobserver reproducibility was assessed as the absolute difference divided by the average of the two observations for all parameters. Statistical Analysis All statistical analyses were performed using SPSS for Windows (version 15.0, SPSS Inc., Chicago, IL, USA). All data were expressed as mean standard deviation. Between-group comparisons were made using paired t-tests or the Mann-Whitney test where necessary. A P-value of <0.05 was considered statistically significant. Univariate and multivariate linear regression analyses were performed in order to identify potential links with global LS. The following independent variables were examined: systolic and diastolic blood pressure, heart rate, blood alcohol level, LV shortening fraction, biplane LV end-diastolic volume, biplane LVEF, aortic time-velocity integral, and E/E.

Results Study Population Among the 25 screened subjects with acute alcohol intoxication, two were excluded from the analysis on account of having at least nonvisualized three LV segments, considered to be of insufficient image quality. The healthy controls without alcohol consumption consisted of 23 subjects. The population participants who consumed alcohol were all men, with a mean age of 25 8 years. Mean blood alcohol level was of 1.3 0.3 g.L1. Mean systolic blood pressure and heart rate were slightly higher in the alcohol group compared to controls, with the differences being statistically significant (147.5 21.8 mmHg vs 127.0 9.9 mmHg, P = 0.003, and 79.7 10.7 bpm vs 70.6 7.6 bpm, P < 0.001, respectively). Clinical characteristics of the two study groups are summarized in Table I.

TABLE I Clinical and Echocardiographic Characteristics of the Population Echocardiographic Measurements Echocardiographic characteristics of the study population are summarized in Table I. There was no significant difference between the subjects who did and did not consume alcohol in terms of LVEF (62.9 4.4% vs. 64.8 5.9%, P = 0.18) or LV shortening fraction (34.7 5.9% vs. 36.0 4.3%, P = 0.54). However, global LS was significantly lower in subjects with alcohol intoxication (17.8 2.0% vs 21.2 1.8%, P < 0.001), larger LV volumes (P < 0.05), and lower aortic time-velocity integral. There was no linear relation between global LS and LV volumes
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or blood pressure, nor was there any correlation between blood alcohol levels and clinical or other echocardiographic parameters. Reproducibility Mean intra- and interobserver variability of global LS was 7% and 8%, respectively. Regression Analyses The results of univariate analysis (P-values) for the different parameters and their relation to global LS are provided in Table II. Systolic blood pressure, blood alcohol level, LV shortening fraction, end-diastolic and end-systolic LV volumes, EF, and time-velocity integral were significantly linked to global LS.

TABLE II Analyses of Association with Altered Global Longitudinal Strain In a multivariate analysis, regarding the separate contribution to global LS of each parameter among all parameters selected, only alcohol intoxication was found to significantly and inversely contribute to global LS (=3.6 1.0, P = 0.005) (Table II). Figure 1 shows an example of GLS analysis in a control subject (A) and intoxicated subject (B).

Figure 1 Example of longitudinal strain in healthy subjects without A. and with B. alcohol intoxication. A. Global longitudinal strain in a healthy control subject without alcohol consumption, and B. global longitudinal strain in a healthy subject with alcohol ...

Discussion In this study, our main finding was that myocardial LS analysis using 2D speckletracking echocardiography allowed us to detect early LV systolic dysfunction immediately after acute alcohol intoxication in men, whereas LVEF and LV shortening fraction did not differ from those of control healthy subjects. Capacity of Global LS to Detect LV Dysfunction Earlier than LVEF and Shortening Fraction in Different Pathophysiological Situations The conventional evaluation of LV systolic function by means of shortening fraction or EF is limited by the percentage variability of measurements (1015%). The assessment of LV longitudinal deformation using 2D speckle tracking has been largely validated against sonomicrometry and MRI as reference methods.8,9 Speckle tracking allows for a quick and easy quantification (<1 min), with greater reproducibility (7% intraobserver variability in our experience) than LVEF or shortening fraction. Moreover, global LS analysis, also known as automated function imaging, permits the exploration of the myocardial pathophysiology in new ways, particularly by detecting early alterations in the longitudinal component of LV systolic function, while the radial component is considered normal.1012 These findings are observed with normal ageing as well as with the typical precursors of heart failure with a normal EF, as seen in hypertension, diabetes, hypertrophic cardiomyopathy, severe aortic stenosis, and ischemia.1015 In hypertensive patients, interstitial and perivascular fibrosis is likely to affect primarily the subendocardium. Longitudinal fibers, as a consequence of their prominent subendocardial location, are more vulnerable to fibrosis and hemodynamic overload. Thus, subendocardial long-axis function may be impaired long before circular fiber dysfunction develops in the midwall or radial fiber dysfunction in the subepicardial layers. Consequently, subendocardial long-axis function is viewed as a potential marker of subclinical LV dysfunction in several disease conditions.13,14 Similarly, longitudinal fibers are more susceptible to ischemia than radial fibers. Thus, there appears to be an entire spectrum of systolic function abnormalities, ranging from normal systolic heart function to systolic heart failure, with heart failure with normal EF being located in between.

Effects of Acute Alcohol Intoxication on LV Function In studies on animals and healthy subjects, alcohol intoxication was shown to cause a dose-dependent impairment of cardiac contractility,5,6 with systemic inflammatory responses being
16

considered

as

one

of

the

underlying

pathophysiological

mechanisms. Ethanol may modify cell activation by specific interactions with cell membrane molecules, thereby involving the innate immune system.16 Several published studies reported a depression in LV contractility following acute ethanol consumption based on invasive hemodynamic approaches,1 systolic time-interval evaluation (preejection period/LV ejection time),2,3 or EF by echocardiography.4 Delgado et al. investigated the effects of oral doses of whiskey on LV function in a group of normal volunteers (n = 13).4 At 30 min after ingesting the alcohol, the heart rate was increased by 11%, while the fractional change across the minor axis of the LV decreased by 6% and LVEF by 4% (P < 0.001). These results, however, have to be interpreted with caution, given the small sample size and considering that LVEF measurements exhibit 1015% variability, particularly when using echocardiographic systems from the mid1970s. By contrast, variability of global LS measurements approximated 7%, as based on our own experience. More recently, a clinical MRI study reported a reversible myocardial injury as defined by myocardial hyperhancement after binge drinking, but without any concomitant decrease in LV systolic function.7This latter study demonstrated that alcohol had no significant effect on LVEF immediately after acute alcohol intoxication, in line with our own observation. Consequently, radial function may be preserved in the initial phase, whereas the longitudinal component could possibly be altered at an earlier stage, which is mainly accounted for by the greater radius of curvature of longitudinal fibers as compared to radial fibers (Laplace's law). Due to the greater radius curvature, the longitudinal myofibers are deemed more susceptible to the different phenomena altering LV contractility compared to radial fibers. Limitations LVEF was evaluated in 2D using biplane Simpson's method, although 3D volume quantification might have been more accurate for quantifying EF and volumes. As only male subjects were included in our study, the effects of alcohol intoxication on LV
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systolic function in women were not assessed. In this study, we did not perform serial echocardiography on the alcohol intoxicated subjects. This should have strengthened our results. Preload and afterload modifications may exert an impact on LV strains. In severe aortic stenosis or hypertensive cardiopathy, afterload elevation was shown to influence more specifically the longitudinal component of LV systolic function, due to the greater radius of curvature of longitudinal fibers. Soon after alcohol intoxication in healthy subjects, blood pressure, heart rate, and volumes were shown to be increased. We, therefore, assumed that preload and afterload elevations may have an impact on global LS. However, multivariate regression analyses demonstrated that blood alcohol levels alone were significantly related to global LS, whereas blood pressure, heart rate, LVEF, and LV volumes were not. Conclusions Global LS by speckle tracking echocardiography allows for a more accurate detection of early LV systolic dysfunction after festive alcohol intoxication compared to LVEF, with the results being independent from blood pressure, heart rate, and LV volumes variations.
References 1. Regan RJ, Koroxenidis G, Moschos CB, et al. The acute metabolic and hemodynamic responses of the left ventricle to ethanol. J Clin Invest. 1966;45:270280. [PMC free article] [PubMed] 2. Ahmed SS, Levinson GE, Regan TJ. Depression of myocardial contractility with low doses of ethanol in normal man. Circulation. 1973;48:378385. [PubMed] 3. Child JS, Kovick RB, Levisman JA, et al. Cardiac effects of acute ethanol ingestion unmasked by autonomic blockade. Circulation. 1979;59:120125. [PubMed] 4. Delgado CE, Gortuin NJ, Ross RS. Acute effects of low doses of alcohol on left ventricular function by echocardiography. Circulation. 1975;51:535540. [PubMed] 5. Guarnieri T, Lakatta EG. Mechanism of myocardial contractile depression by clinical concentrations of ethanol. A study in ferret papillary muscles. J Clin Invest. 1990;85:14621467. [PMC free article][PubMed] 6. Kelbaek H, Gjrup T, Brynjolf I, et al. Acute effects of alcohol on left ventricular function in healthy subjects at rest and during upright exercise. Am J Cardiol. 1985;55:164167. [PubMed] 7. Zagrosek A, Messroghli D, Schulz O, et al. Effect of binge drinking on the heart as assessed by cardiac magnetic resonance imaging. JAMA. 2010;304:13281330. [PubMed] 8. Leitman M, Lysyansky P, Sidenko S, et al. Two-dimensional strain- a novel software for real-time quantitative echocardiographic assessment of myocardial function. J Am Soc Echocardiogr.2004;17:10211029. [PubMed]

9. Amundsen BH, Helle-Valle T, Edvardsen T, et al. Noninvasive myocardial strain measurement by speckle tracking echocardiography: Validation against sonomicrometry and tagged magnetic resonance imaging. J Am Coll Cardiol. 2006;47:789793. [PubMed] 10. Serri K, Reant P, Lafitte M, et al. Global and regional myocardial function quantification by two-dimensional strain: Application in hypertrophic cardiomyopathy. J Am Coll Cardiol. 2006;47:11751181. [PubMed] 11. Lafitte S, Perlant M, Reant P, et al. Impact of impaired myocardial deformations on exercise tolerance and prognosis in patients with asymptomatic aortic stenosis. Eur J Echocardiogr.2009;10:414419. [PubMed] 12. Reant P, Lafitte S, Bougteb H, et al. Effect of catheter ablation for isolated paroxysmal atrial fibrillation on longitudinal and circumferential left ventricular systolic function. Am J Cardiol.2009;103:232237. [PubMed] 13. Sanderson JE. Heart failure with a normal ejection fraction. Heart. 2007;93:155158.[PMC free article] [PubMed] 14. Fang ZY, Leano R, Marwick TH. Relationship between longitudinal and radial contractility in subclinical diabetic heart disease. Clin Sci (Lond) 2004;106:5360. [PubMed] 15. Zghal F, Bougteb H, Reant P, et al. Assessing global and regional left ventricular myocardial function in elderly patients using the bidimensional strain method. Echocardiography. 2011;28:978982.[PubMed] 16. Goral J, Karavitis J, Kovacs EJ. Exposure-dependent effects of ethanol on the innate immune system. Alcohol. 2008;42:237247. [PMC free article] [PubMed]

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chocardiography . 2012 September , 29 ( 8 ) : 927-932 . Diterbitkan online 2012 Mei 29. doi : 10.1111/j.1540-8175.2012.01717.x PMCID : PMC3465776
Deteksi Dini Kiri ventrikel sistolik Disfungsi Menggunakan Dua Dimensi Speckle Pelacakan Evaluasi Galur di Subjek Sehat setelah intoksikasi akut Alkohol Patricia Reant , MD , Ph.D. , Warren Chasseriaud , MD , Xavier Pillois , Ph.D. , Marina Dijos , MD , Florence Arsac , MD , Raymond Roudaut , MD , dan Stephane Lafitte , MD , Ph.D.

Informasi Penulis Hak Cipta dan Informasi Lisensi abstrak Tujuan : Kami mengevaluasi kemampuan dua dimensi belu pelacakan regangan echocardiography untuk mendeteksi ventrikel kiri ( LV ) disfungsi sistolik dibandingkan dengan fraksi ejeksi LV ( EF ) pada subyek sehat setelah keracunan alkohol akut . Metode dan Hasil : Secara total , 25 subyek sehat diselidiki menggunakan echocardiography 4-6 jam setelah timbulnya keracunan alkohol pada pertemuan meriah regional, dan kemudian dibandingkan dengan 23 subyek kontrol sehat tanpa konsumsi alkohol . Denyut jantung, tekanan darah , kadar alkohol , volume LV , EF , fraksi pemendekan , E / rasio A , serta ketegangan membujur dunia ( LS ) dicatat. Berarti tingkat alkohol darah adalah 1,3 0,3 g.L - 1 . Berarti tekanan darah sistolik dan denyut jantung yang sedikit meningkat pada kelompok alkohol dibandingkan dengan kontrol ( 147,5 21,8 mmHg vs 127,0 9,9 mmHg , P = 0,003 , dan 79,7 10,7 vs 70,6 bpm 7,6 bpm , P < 0,001 , masing-masing) . Sementara tidak ada perbedaan yang signifikan dalam hal LVEF ( 62,9 4,4 % vs 64,8 5,9 % , P = 0,18 ) atau fraksi shortening ( 34,7 5,9 % vs 36,0 4,3 % , P = 0.54 ) , LS global gangguan signifikan ( -17,8 2,0 % vs 21,2 1,8 % , P < 0,001 ) . Selain itu, subyek yang mengkonsumsi alkohol telah meningkat LV akhir diastolik ( 108,3 20,1 mL vs 95,5 14,6 mL , P = 0,037 ) dan volume akhir sistolik ( 41,6 11,4 mL vs 33,7 6,9 mL , P = 0,024 ) , bersama dengan depresi aorta waktu - kecepatan integral ( 19,9 3,2 mL vs 21,9 2,5 mL , P = 0,034 ) . Menurut multivariat analisis regresi linier , tingkat alkohol darah adalah satu-satunya faktor signifikan yang berkaitan dengan dunia LS ( = -3.6 1.0 , P = 0,005 ) . Kesimpulan : keracunan Alkohol sekitar hari-hari perayaan menginduksi kontraksi LV
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kelainan akut, yang dapat dideteksi menggunakan LS global dengan belu pelacakan pada tahap awal dan lebih akurat daripada LVEF menurun . Kata kunci : pesta minuman keras , belu pelacakan ketegangan echocardiography , keracunan alkohol Studi sebelumnya telah melaporkan depresi dalam ventrikel kiri ( LV ) kontraktilitas setelah konsumsi etanol akut didasarkan pada pendekatan hemodinamik invasif , 1 sistolik evaluasi interval waktu ( periode preejection / LV waktu ejeksi ) , 2,3 atau fraksi ejeksi ( EF ) dengan echocardiography . 4 Dalam studi pada hewan dan subyek sehat , alkohol keracunan terbukti menyebabkan penurunan dosis-tergantung dari kontraktilitas jantung , 5,6 dengan respon inflamasi sistemik yang dianggap sebagai salah satu mekanisme patofisiologi . Sebuah pencitraan resonansi magnetik studi klinis terbaru ( MRI ) melaporkan cedera miokard reversibel dengan hyperenhancement miokard setelah pesta minuman keras , tetapi tanpa penurunan LV sistolik function.7 Analisis deformasi miokard menggunakan dua dimensi ( 2D ) spekel echocardiography pelacakan telah divalidasi , menunjukkan tingkat tinggi reproduktifitas dan akurasi dalam mendeteksi halus awal LV sistolik kelainan fungsi ( deformasi memanjang depresi ) pada pasien gangguan jantung tanpa diubah EF.8 - 14 Oleh karena itu , penelitian kami bertujuan untuk mengetahui kemampuan 2D belu pelacakan regangan echocardiography untuk mendeteksi dini LV sistolik disfungsi dibandingkan dengan evaluasi LVEF konvensional pada subyek sehat setelah keracunan alkohol akut versus kelompok kontrol subyek nonintoxicated sehat . metode studi Protokol Selama pertemuan meriah regional, berturut-turut subjek pria sehat dirawat di pusat kesehatan secara berurutan dievaluasi oleh pengamat yang sama menggunakan echocardiography , 3 sampai 4 jam setelah timbulnya keracunan alkohol akut . Sebuah kelompok kontrol relawan , yang terdiri dari mahasiswa kedokteran di kami kardiologi University Hospital , direkrut , mengingat kondisi bahwa mereka tidak mengkonsumsi alkohol setidaknya 10 hari sebelum studi .

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Untuk memenuhi syarat sebagai subyek sehat , subyek harus bebas dari penyakit yang dikenal jantung, diabetes , dan hipertensi . Penelitian ini dikecualikan subyek menyajikan cukup USG kualitas gambar , yang didefinisikan sebagai lebih dari tiga segmen LV yang suboptimally divisualisasikan dengan ekokardiografi konvensional . Pengukuran echocardiographic dilakukan oleh pengamat kedua , buta ke tingkat subyek ' dari konsumsi alkohol . Sistolik dan diastolik tekanan darah, denyut jantung , dan tingkat alkohol darah secara sistematis diukur segera sebelum echocardiography tersebut . Dalam rangka untuk memperkirakan tingkat alkohol darah, Breathalyzer portabel disetujui oleh Otoritas Nasional digunakan , dengan pengukuran yang diulang tiga kali dan nilai rata-rata mereka ditentukan . Informed consent tertulis diperoleh dari semua mata pelajaran . Sesuai dengan pedoman etika lokal , studi observasional dirancang untuk dilakukan dalam konteks perayaan populer . Transtorakal ekokardiografi Akuisisi data Subyek diperiksa pada posisi dekubitus lateral kiri menggunakan Q scanner ultrasound komersial Vivid ( General Electric Healthcare , Haifa , Israel ) dengan bertahap-array transduser ( M4S - RS ) . Setelah itu , akuisisi data yang 2D diperoleh , termasuk pandangan jangka panjang dan pendek sumbu parasternal dan tiga tampilan apikal standar. Untuk setiap tampilan , tiga siklus berturut-turut jantung dicatat selama respirasi tenang. Rekaman Grey- skala yang dioptimalkan untuk evaluasi LV pada frame rate rata-rata minimal 50 detik - 1 . Warna Doppler rekaman diperoleh untuk mengecualikan disfungsi katup , dan rekaman aliran Doppler dilakukan dengan sapuan kecepatan horizontal dari 100 mm / detik . Analisis echocardiographic Semua pengukuran standar diambil oleh pengamat yang sama menggunakan perangkat lunak khusus ( EchoPac PC , versi BT11 , Listrik Sistem Pengobatan Umum , Horten , Norwegia ) , termasuk persentase LV memperpendek pecahan , LV saluran keluar waktu
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- kecepatan terpisahkan , kecepatan puncak E - dan A- gelombang masuknya mitral , serta analisis Doppler jaringan max kecepatan E ' puncak pada anulus mitral lateral. E / E ' rasio dihitung untuk mewakili LV tekanan akhir diastolik . Berdasarkan apikal empat dan dua ruang pandangan, volume LV dan EF diukur sesuai dengan Aturan Simpson . Semua pengukuran dilakukan dengan rata-rata tiga siklus jantung . Untuk membujur regangan ( LS ) analisis , perangkat lunak secara otomatis melacak kontur pada frame berikutnya setelah tiga penanda endokardium ditempatkan dalam kerangka akhir diastolik . Pelacakan yang memadai dapat diverifikasi secara real time dan dikoreksi dengan menyesuaikan daerah bunga atau manual dengan memperbaiki kontur sehingga untuk memastikan pelacakan yang optimal . Selain itu, LS dinilai dalam pandangan apikal . LS Rata-rata dihitung untuk 17 segmen dalam kaitannya dengan besarnya regangan pada penutupan katup aorta . Deformasi sistolik Longitudinal ditandai sebagai shortening , dan menggunakan definisi regangan , indeks sistolik menghasilkan nilai negatif . reproduktifitas Para pengamat kedua melakukan semua pengukuran echocardiographic , yang kemudian diulang membabi buta untuk setiap parameter . Data juga dianalisis oleh pengamat buta ketiga 10 dari subyek . Intraobserver reproduksibilitas dihitung menggunakan perbedaan rata-rata antara 10 pengukuran , dan interobserver reproduktifitas dinilai sebagai perbedaan mutlak dibagi dengan rata-rata dua pengamatan untuk semua parameter . Analisis Statistik Semua analisa statistik dilakukan dengan menggunakan program SPSS for Windows ( versi 15.0 , SPSS Inc , Chicago , IL , USA ) . Semua data dinyatakan sebagai rata-rata standar deviasi . Perbandingan antara kelompok dibuat menggunakan paired t - tes atau uji Mann Whitney jika diperlukan . Sebuah P-nilai < 0,05 dianggap signifikan secara statistik . Analisis regresi linier univariat dan multivariat dilakukan untuk mengidentifikasi link potensial dengan LS global. Variabel independen berikut diperiksa : tekanan darah sistolik dan diastolik , denyut jantung , kadar alkohol , shortening fraksi LV , biplan LV volume akhir diastolik , LVEF biplan , aorta waktu - kecepatan terpisahkan , dan E / E ' .

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hasil studi Populasi Di antara 25 mata pelajaran disaring dengan keracunan alkohol akut , dua dikeluarkan dari analisis karena memiliki setidaknya nonvisualized tiga segmen LV , dianggap kualitas gambar cukup . Kontrol sehat tanpa konsumsi alkohol terdiri dari 23 mata pelajaran . Para peserta penduduk yang mengkonsumsi alkohol semua laki-laki , dengan usia ratarata 25 8 tahun . Berarti tingkat alkohol dalam darah adalah 1,3 0,3 gL - 1 . Berarti tekanan darah sistolik dan denyut jantung yang sedikit lebih tinggi pada kelompok alkohol dibandingkan dengan kontrol , dengan perbedaan-perbedaan yang signifikan secara statistik ( 147,5 21,8 mmHg vs 127,0 9,9 mmHg , P = 0,003 , dan 79,7 10,7 vs 70,6 bpm 7,6 bpm , P <0,001 , masing-masing) . Karakteristik klinis dari dua kelompok belajar diringkas dalam Tabel I.

TABEL I Karakteristik klinis dan ekokardiografi dari Penduduk Pengukuran echocardiographic Karakteristik echocardiographic populasi penelitian dirangkum dalam Tabel I. Tidak ada perbedaan yang signifikan antara subyek yang melakukan dan tidak mengkonsumsi alkohol dalam hal LVEF ( 62,9 4,4 % vs 64,8 5,9 % , P = 0,18 ) atau LV shortening fraksi ( 34,7 5,9 % vs 36,0 4,3 % , P = 0.54 ) . Namun, LS global yang secara signifikan lebih rendah pada subyek dengan keracunan alkohol ( -17,8 2,0 % vs -21,2 1,8 % , P < 0,001 ) , volume LV lebih besar ( P <0,05 ) , dan bawah aorta waktu - kecepatan terpisahkan . Tidak ada hubungan linear antara LS global dan volume LV atau tekanan darah , juga tidak ada hubungan antara tingkat alkohol dalam darah dan parameter echocardiographic klinis atau lainnya . reproduktifitas Berarti intra dan interobserver variabilitas LS global 7 % dan 8 % , masing-masing.
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Analisis regresi Hasil analisis univariat ( P - nilai ) untuk parameter yang berbeda dan hubungannya dengan LS global pada Tabel II . Tekanan darah sistolik , kadar alkohol , shortening fraksi LV , akhir diastolik dan akhir sistolik volume LV , EF , dan integral waktu kecepatan secara signifikan terkait dengan LS global.

TABEL II Analisis Asosiasi dengan Diubah Regangan longitudinal global Dalam analisis multivariat , mengenai kontribusi terpisah untuk LS global setiap parameter antara semua parameter yang dipilih , hanya keracunan alkohol ditemukan secara signifikan dan berbanding terbalik berkontribusi LS dunia ( = -3.6 1.0 , P = 0,005 ) ( Tabel II ) . Gambar 1 menunjukkan contoh analisis GLS di subjek kontrol ( A ) dan tunduk mabuk ( B).

Gambar 1 Contoh regangan longitudinal pada subyek sehat tanpa A. dan B. dengan keracunan alkohol . A. global regangan longitudinal pada subjek kontrol sehat tanpa konsumsi alkohol , dan B. ketegangan membujur global dalam subjek yang sehat dengan alkohol ... diskusi Dalam studi ini , Temuan utama kami adalah bahwa analisis LS miokard menggunakan 2D belu - pelacakan echocardiography memungkinkan kami untuk mendeteksi dini LV sistolik disfungsi segera setelah keracunan alkohol akut pada pria , sedangkan LVEF dan shortening fraksi LV tidak berbeda dari subyek sehat kontrol. Kapasitas LS Global Mendeteksi LV Disfungsi Awal dari LVEF dan Shortening Fraksi dalam Situasi patofisiologi Berbeda

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Evaluasi konvensional LV fungsi sistolik dengan cara memperpendek fraksi atau EF dibatasi oleh persentase variabilitas pengukuran ( 10-15 % ) . Penilaian deformasi memanjang LV menggunakan 2D Speckle pelacakan sebagian besar telah divalidasi terhadap sonomicrometry dan MRI sebagai acuan methods.8 , 9 Speckle pelacakan memungkinkan untuk kuantifikasi cepat dan mudah ( < 1 menit ) , dengan reproduktifitas lebih besar ( 7 % intraobserver variabilitas dalam kami pengalaman) dari LVEF atau fraksi pemendekan . Selain itu, analisis LS global, juga dikenal sebagai pencitraan fungsi otomatis , memungkinkan eksplorasi patofisiologi miokard dengan cara baru , terutama dengan mendeteksi perubahan awal dalam komponen longitudinal LV fungsi sistolik , sedangkan komponen radial dianggap normal.10 - 12 ini temuan ini diamati dengan penuaan normal maupun dengan prekursor khas gagal jantung dengan EF normal, seperti yang terlihat pada hipertensi , diabetes , kardiomiopati hipertrofik , stenosis aorta berat , dan ischemia.10 - 15 pada pasien hipertensi , dan fibrosis interstisial perivaskular adalah cenderung mempengaruhi terutama subendokardium tersebut . Serat longitudinal , sebagai konsekuensi dari lokasi subendocardial terkemuka mereka, lebih rentan terhadap fibrosis dan kelebihan hemodinamik . Dengan demikian , fungsi subendocardial panjang sumbu mungkin terganggu lama sebelum disfungsi serat melingkar berkembang di midwall atau disfungsi serat radial di lapisan subepicardial . Akibatnya, subendocardial fungsi panjang sumbu dipandang sebagai penanda potensi subklinis LV disfungsi dalam beberapa penyakit conditions.13 , 14 Demikian pula , serat memanjang lebih rentan terhadap iskemia dari serat radial . Dengan demikian , tampaknya ada seluruh spektrum kelainan fungsi sistolik , mulai dari fungsi jantung sistolik normal gagal jantung sistolik , dengan gagal jantung dengan EF yang normal yang terletak di antara . Pengaruh Alkohol Kemabukan Akut pada LV Fungsi Dalam studi pada hewan dan subyek sehat , alkohol keracunan terbukti menyebabkan penurunan dosis-tergantung dari kontraktilitas jantung , 5,6 dengan respon inflamasi sistemik yang dianggap sebagai salah satu yang mendasari patofisiologi mechanisms.16 Etanol dapat mengubah aktivasi sel dengan interaksi tertentu dengan molekul membran sel , sehingga melibatkan bawaan system.16 kekebalan tubuh Beberapa penelitian yang diterbitkan melaporkan depresi di LV kontraktilitas setelah konsumsi etanol akut didasarkan pada pendekatan hemodinamik invasif , 1 sistolik
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evaluasi interval waktu ( periode preejection / LV waktu ejeksi ) , 2,3 atau EF dengan echocardiography.4 Delgado et al . meneliti efek dari dosis oral wiski pada fungsi LV dalam kelompok sukarelawan normal ( n = 13 ) .4 Pada 30 menit setelah menelan alkohol , denyut jantung meningkat sebesar 11 % , sedangkan perubahan fraksional di sumbu minor dari LV mengalami penurunan sebesar 6 % dan LVEF sebesar 4% ( P < 0,001 ) . Hasil ini , bagaimanapun, harus ditafsirkan dengan hati-hati , mengingat ukuran sampel yang kecil dan mengingat bahwa pengukuran LVEF menunjukkan variabilitas 10-15 % , terutama ketika menggunakan sistem echocardiographic dari pertengahan 1970-an . Sebaliknya , variabilitas pengukuran LS global yang diperkirakan 7 % , karena berdasarkan pengalaman kita sendiri . Baru-baru ini , sebuah studi klinis MRI dilaporkan cedera miokard reversibel seperti yang didefinisikan oleh hyperhancement miokard setelah pesta minuman keras , tetapi tanpa penurunan seiring LV sistolik function.7This studi terakhir menunjukkan bahwa alkohol tidak berpengaruh signifikan terhadap LVEF setelah keracunan alkohol akut , di sejalan dengan pengamatan kami sendiri . Akibatnya , fungsi radial dapat dipertahankan dalam tahap awal , sedangkan komponen memanjang mungkin bisa diubah pada tahap awal , yang terutama dicatat dengan radius lebih dari kelengkungan serat memanjang dibandingkan dengan serat radial (hukum Laplace ) . Karena semakin besar kelengkungan radius , para myofibers memanjang dianggap lebih rentan terhadap fenomena yang berbeda mengubah LV kontraktilitas dibandingkan dengan serat radial . keterbatasan LVEF dievaluasi dalam 2D menggunakan metode biplan Simpson , meskipun volumenya 3D kuantifikasi mungkin lebih akurat untuk mengukur EF dan volume . Karena hanya subjek laki-laki dilibatkan dalam penelitian kami, efek dari alkohol keracunan pada LV fungsi sistolik pada wanita tidak dinilai. Dalam studi ini , kami tidak melakukan echocardiography serial pada mata pelajaran mabuk alkohol. Ini harus telah memperkuat hasil kami . Preload dan afterload modifikasi mungkin menyebabkan dampak pada strain LV . Dalam stenosis aorta berat atau cardiopathy hipertensi , elevasi afterload ditunjukkan untuk mempengaruhi lebih spesifik komponen longitudinal LV fungsi sistolik , karena radius
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lebih dari kelengkungan serat longitudinal. Segera setelah alkohol keracunan pada subyek sehat , tekanan darah , denyut jantung , dan volume yang ditampilkan untuk ditingkatkan . Karena itu, kami mengasumsikan bahwa preload dan afterload ketinggian mungkin berdampak pada LS global. Namun, analisis regresi multivariat menunjukkan bahwa kadar alkohol dalam darah sendiri secara signifikan terkait dengan LS global, sedangkan tekanan darah , denyut jantung , LVEF , dan LV volume tidak . kesimpulan LS global dengan bintik echocardiography pelacakan memungkinkan untuk deteksi yang lebih akurat dari awal LV sistolik disfungsi setelah meriah keracunan alkohol dibandingkan dengan LVEF , dengan hasil yang independen dari tekanan darah , denyut jantung , dan LV volume variasi .

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