Abstract：
UNASSIGNED: Elevated blood cobalt levels secondary to metal-on-metal (MoM) hip arthroplasties are a suggested risk factor for developing cardiovascular complications including cardiomyopathy. Clinical studies assessing patients with MoM hips using left ventricular ejection fraction (LVEF) have found conflicting evidence of cobalt-induced cardiomyopathy. Global longitudinal strain (GLS) is an echocardiography measurement known to be more sensitive than LVEF when diagnosing early cardiomyopathies. The extent of cardiovascular injury, as measured by GLS, in patients with elevated blood cobalt levels has not previously been examined.
UNASSIGNED: A total of 16 patients with documented blood cobalt ion levels above 13 µg/l (13 ppb, 221 nmol/l) were identified from a regional arthroplasty database. They were matched with eight patients awaiting hip arthroplasty. All patients underwent echocardiography, including GLS, investigating potential signs of cardiomyopathy.
UNASSIGNED: Patients with MoM hip arthroplasties had a mean blood cobalt level of 29 µg/l (495 nmol/l) compared to 0.01 µg/l (0.2 nmol/l) in the control group. GLS readings were available for seven of the MoM cohort, and were significantly lower when compared with controls (-15.5% vs -18% (MoM vs control); p = 0.025)). Pearson correlation demonstrated that GLS significantly correlated with blood cobalt level (r = 0.8521; p < 0.001). However, there were no differences or correlations for other echocardiography measurements, including LVEF (64.3% vs 63.7% (MoM vs control); p = 0.845).
UNASSIGNED: This study supports the hypothesis that patients with elevated blood cobalt levels above 13 µg/l in the presence of a MoM hip implant may have impaired cardiac function compared to a control group of patients awaiting hip arthroplasty. It is the first study to use the more sensitive parameter of GLS to assess for any cardiac contractile dysfunction in patients with a MoM hip implant and a normal LVEF. Larger studies should be performed to determine the potential of GLS as a predictor of cardiac complications in patients with MoM arthroplasties.
UNASSIGNED: A total of 16 patients with documented blood cobalt ion levels above 13 µg/l (13 ppb, 221 nmol/l) were identified from a regional arthroplasty database. They were matched with eight patients awaiting hip arthroplasty. All patients underwent echocardiography, including GLS, investigating potential signs of cardiomyopathy.
UNASSIGNED: Patients with MoM hip arthroplasties had a mean blood cobalt level of 29 µg/l (495 nmol/l) compared to 0.01 µg/l (0.2 nmol/l) in the control group. GLS readings were available for seven of the MoM cohort, and were significantly lower when compared with controls (-15.5% vs -18% (MoM vs control); p = 0.025)). Pearson correlation demonstrated that GLS significantly correlated with blood cobalt level (r = 0.8521; p < 0.001). However, there were no differences or correlations for other echocardiography measurements, including LVEF (64.3% vs 63.7% (MoM vs control); p = 0.845).
UNASSIGNED: This study supports the hypothesis that patients with elevated blood cobalt levels above 13 µg/l in the presence of a MoM hip implant may have impaired cardiac function compared to a control group of patients awaiting hip arthroplasty. It is the first study to use the more sensitive parameter of GLS to assess for any cardiac contractile dysfunction in patients with a MoM hip implant and a normal LVEF. Larger studies should be performed to determine the potential of GLS as a predictor of cardiac complications in patients with MoM arthroplasties.
摘要：
■继发于金属对金属（MoM）髋关节置换术的血钴水平升高是导致心血管并发症（包括心肌病）的危险因素。使用左心室射血分数（LVEF）评估MoM髋关节患者的临床研究发现钴引起的心肌病的证据相互矛盾。全局纵向应变（GLS）是一种超声心动图测量，在诊断早期心肌病时比LVEF更敏感。心血管损伤的程度，以GLS衡量，在血钴水平升高的患者中，以前没有检查过。
■共有16例血钴离子水平超过13µg/l（13ppb，从区域关节成形术数据库中确定221nmol/l）。他们与八名等待髋关节置换术的患者相匹配。所有患者均行超声心动图检查,包括GLS,研究心肌病的潜在体征。
■患有MoM髋关节置换术的患者的平均血液钴水平为29µg/l（495nmol/l），而对照组为0.01µg/l（0.2nmol/l）。GLS读数可用于MoM队列中的七个，与对照组相比，显着降低（-15.5％vs-18％（MoMvs对照组）；p=0.025））。Pearson相关性显示GLS与血钴水平显著相关(r=0.8521;p<0.001)。然而,其他超声心动图测量没有差异或相关性，包括LVEF（64.3%vs63.7%（MoMvs对照组）；p=0.845）。
■这项研究支持以下假设：与等待髋关节置换术的对照组患者相比，在MoM髋关节植入物存在的情况下血钴水平高于13µg/l的患者可能具有心脏功能受损。这是第一项使用GLS更敏感的参数来评估MoM髋关节植入物和正常LVEF患者的任何心脏收缩功能障碍的研究。应进行更大规模的研究，以确定GLS作为MoM关节置换术患者心脏并发症的预测指标。
■共有16例血钴离子水平超过13µg/l（13ppb，从区域关节成形术数据库中确定221nmol/l）。他们与八名等待髋关节置换术的患者相匹配。所有患者均行超声心动图检查,包括GLS,研究心肌病的潜在体征。
■患有MoM髋关节置换术的患者的平均血液钴水平为29µg/l（495nmol/l），而对照组为0.01µg/l（0.2nmol/l）。GLS读数可用于MoM队列中的七个，与对照组相比，显着降低（-15.5％vs-18％（MoMvs对照组）；p=0.025））。Pearson相关性显示GLS与血钴水平显著相关(r=0.8521;p<0.001)。然而,其他超声心动图测量没有差异或相关性，包括LVEF（64.3%vs63.7%（MoMvs对照组）；p=0.845）。
■这项研究支持以下假设：与等待髋关节置换术的对照组患者相比，在MoM髋关节植入物存在的情况下血钴水平高于13µg/l的患者可能具有心脏功能受损。这是第一项使用GLS更敏感的参数来评估MoM髋关节植入物和正常LVEF患者的任何心脏收缩功能障碍的研究。应进行更大规模的研究，以确定GLS作为MoM关节置换术患者心脏并发症的预测指标。
