aterosklerozАтеросклерозAteroscleroz2078-256X2949-3633НИИТПМ-филиал ИЦиГ СО РАНateroskleroz-45Research ArticleОБЗОРЫREVIEWSДЕФОРМАЦИЯ МИОКАРДА ЛЕВОГО ЖЕЛУДОЧКА: ПОЛОВОЗРАСТНЫЕ ХАРАКТЕРИСТИКИ И АССОЦИАЦИИ С СЕРДЕЧНО-СОСУДИСТЫМИ ЗАБОЛЕВАНИЯМИLEFT VENTRICULAR STRAIN: SEX- AND AGE-RELATED CHARACTERISTICS AND ASSOCIATIONS WITH CARDIOVASCULAR DISEASES (REVIEW OF LITERATURE)ГусеваВ. П.GusevaV. P.gusevaofficial@gmail.comМалютинаС. К.MalyutinaS. K.smalyutina@hotmail.comРябиковА. Н.RyabikovA. N.andrew_ryabikov@mail.ruВоронинаЕ. В.VoroninaE. V.Voroninacat@gmail.comШубкинаЕ. В.ShubkinaE. V.Lenasha07@list.ruСиневаА. И.SinyovaA. I.Doc.sineva@gmail.comФГБНУ НИИ терапии и профилактической медициныInstitute of Internal and Preventive MedicineФГБНУ НИИ терапии и профилактической медициныInstitute of Internal and Preventive Medicine; Novosibirsk State Medical UniversityФГБОУ ВО Новосибирский государственный медицинский университет Минздрава РоссииNovosibirsk State Medical University2017270920191324149Copyright © Гусева В.П., Малютина С.К., Рябиков А.Н., Воронина Е.В., Шубкина Е.В., Синева А.И., 20192019Гусева В.П., Малютина С.К., Рябиков А.Н., Воронина Е.В., Шубкина Е.В., Синева А.И.Guseva V.P., Malyutina S.K., Ryabikov A.N., Voronina E.V., Shubkina E.V., Sinyova A.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://ateroskleroz.elpub.ru/jour/article/view/45

Cтандартные показатели функции левого желудочка (ЛЖ) (фракция выброса, конечный диастолический и конечный систолический объемы, визуальная оценка локальной сократимости) зависимы от вариаций гемодинамической нагрузки и частично субъективны. Технология оценки деформации миокарда позволяет объективизировать оценку функции ЛЖ и выявить изменения уже при субклинических поражениях миокарда. Цель исследования. В настоящем обзоре проведен анализ литературных данных, посвященных ультразвуковой оценке деформации миокарда (Strain) при различных сердечно-сосудистых заболеваниях (ССЗ), опубликованных за 15 лет (2001-2016) с использованием ресурсов PubMed (https://www.ncbi.nlm.nih.gov/pubmed) и Google Академия (https://scholar.google.ru). Результаты. Выделяют продольный, циркулярный и радиальный Strain миокарда ЛЖ как трехмерного объекта. Согласно полученным данным, показатели деформации миокарда зависят от пола (ниже у мужчин, чем у женщин) и возраста (снижаются с возрастом), имеют диагностическую значимость при инфаркте миокарда, острой и хронической сердечной недостаточности (СН), кардиомиопатиях, в меньшей степени исследованы их характеристики при артериальной гипертензии, некоторых субклинических поражениях миокарда. В немногочисленных клинических работах продемонстрировано предиктивное значение параметров деформации в отношении осложнений и исходов ССЗ. Единичные исследования в популяции выявили ассоциации деформации ЛЖ с риском острых коронарных событий, злокачественных аритмий, СН, смерти от ССЗ и всех причин (с коэффициентами риска порядка 1,3 для ИБС, 1,7 для СН и 1,6-2,0 для фатальных ССЗ и общей смертности). Заключение. Технология оценки деформации ЛЖ является перспективной. В настоящее время остается нерешенным вопрос о референсных значениях в зависимости от пола и возраста, требуются дальнейшие исследования деформации ЛЖ для ранней диагностики систолической дисфункции и оценки связи с факторами риска и прогнозом ССЗ.

The standard indicators of function of the left ventricle (LV) (ejection fraction, end-diastolic and end-systolic volumes, of local contractility) depend on the circulation load and partly are subjective. The indices of myocardial deformation allow to objectify the assessment of left ventricular function and to detect changes even in subclinical myocardial lesion. Objectives. This review analyzes the literature data focused on the ultrasound assessment of myocardial deformation (Strain) in various cardiovascular diseases (CVD), published during the last 15 years (2001-2016) using PubMed (https://www.ncbi.nlm.nih.gov/pubmed) and Google Scholar (https://scholar.google.ru). Results. The deformation of LV myocardium, as a 3D object, is considered as a longitudinal, circular and radial Strain. According to data obtained, the indicators of myocardial Strain are related to age and sex (in men lower than in women, decreased with aging), they have diagnostic significance for myocardial infarction, acute and chronic heart failure (HF), cardiomyopathy, Strain characteristics in hypertension and subclinical myocardial damage are investigated less. Not numerous clinical studies have demonstrated predictive value of Strain in respect to CVD complications and outcomes. Very few studies available are available in population, they revealed the association between LV Strain with the risk of acute coronary events, malignant arrhythmias, HF, death from CVD and from all causes (risk coefficients were around 1.3 for CHD, 1.7 for HF and 1.6-2.0 for fatal CVD and total mortality). Conclusion. Strain technology is perspective. Currently, the age- and sex- specific reference values of Strain are still under the question; further studies of LV Strain are warranted for assessment of early systolic dysfunction and investigation of association with CVD risk factors and prognosis.

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The authors declare that there are no conflicts of interest present.