应用左室压力-应变环评价不同程度冠状动脉狭窄患者心肌做功的定量研究

Quantitative study of left ventricular pressure strain loop in evaluating myocardial work in patients with different degrees of coronary artery stenosis

目的应用左室压力-应变环(PSL)评价左室射血分数正常、无节段性室壁运动异常的不同程度冠状动脉狭窄患者心肌做功情况,探讨心肌做功参数预测冠状动脉重度狭窄的临床价值。方法前瞻性收集2020年12月至2021年8月期间在济宁医学院附属医院拟行冠状动脉造影(CAG)的238例患者的资料。根据CAG结果,分为对照组、中度狭窄组、重度狭窄(1~2支)组、重度狭窄(复杂多支)组。应用PSL评估左室纵向应变(GLS)、整体做功指数(GWI)、整体有用功(GCW)、整体无用功(GWW)、整体做功效率(GWE),采用单因素和多因素logistic回归分析冠状动脉重度狭窄的影响因素,并构建受试者工作特征(ROC)曲线分析GLS、GWI、GCW、GWW和GWE对冠状动脉重度狭窄的预测价值。结果重度狭窄组GLS、GWI、GCW、GWE低于对照组、中度狭窄组(均P<0.05),而GWW高于对照组、中度狭窄组(均P<0.05);重度狭窄(复杂多支)组GWI、GCW、GWE低于重度狭窄(1~2支)组(均P<0.05),而GWW高于重度狭窄(1~2支)组(P<0.05)。多因素logistic回归分析结果显示GWE是冠状动脉重度狭窄的独立影响因素(OR=0.266,P<0.05)。与GLS、GWI、GCW、GWW相比,GWE预测冠状动脉重度狭窄的曲线下面积(0.920)最大,灵敏度为92.24%,特异度为73.77%。两位超声医师分析得出的GWI、GCW、GWW、GWE观察者内及观察者间相关系数分别为0.916和0.907、0.989和0.981、0.932和0.955、0.931和0.937,结果显示重复性较好。结论PSL为冠状动脉狭窄患者左室收缩功能的定量评估提供了一种新方法,GWE可作为预测冠状动脉重度狭窄患者的敏感指标,值得在临床中推广应用。

Objective To evaluate the myocardial work of patients with different degrees of coronary artery stenosis with normal left ventricular ejection fraction and no segmental ventricular wall motion abnormality by left ventricular pressure-strain ring(PSL),and to explore the clinical value of myocardial work parameters in predicting severe coronary artery stenosis.Methods The data of 238 patients undergoing coronary angiography(CAG)in the Affiliated Hospital of Jining Medical University from December 2020 to August 2021 was prospectively collected.According to the results of CAG,the patients were divided into control group,moderate stenosis group,severe stenosis(1-2 branches)group,severe stenosis(complex multiple branches)group.Global longitudinal strain(GLS),global work index(GWI),global constructive work(GCW),global work waste(GWW)and global work efficiency(GWE)were measured by PSL.Univariate and multivariate logistics regression were used to analyze the influencing factors of severe coronary artery stenosis.The receiver operating characteristic(ROC)curve was constructed to analyze the predictive value of GLS,GWI,GCW,GWW and GWE for severe coronary artery stenosis.Results The GLS,GWI,GCW and GWE in severe stenosis group were lower than those in control group and moderate stenosis group(all P<0.05),while GWW was higher than those in control group and moderate stenosis group(all P<0.05);the GWI,GCW and GWE in severe stenosis(complex multiple branches)group were lower than those in severe stenosis(1-2 branches)group(all P<0.05),while GWW was higher than those in severe stenosis(1-2 branches)group(all P<0.05).Multivariate logistic regression analysis showed that GWE was an independent influencing factor for severe coronary stenosis(OR=0.266,P<0.05).Compared with GLS,GWI,GCW and GWW,GWE had the largest area under the curve(0.920)to predict severe coronary stenosis,with sensitivity of 92.24%and specificity of 73.77%.The intra observer and inter observer correlation coefficients of GWI,GCW,GWW and GWE analyzed by two ultrasound physicians were 0.916 and 0.907,0.989 and 0.981,0.932 and 0.955,0.931 and 0.937,respectively,which showed good repeatability.Conclusions PSL provides a new method for quantitative evaluation of left ventricular systolic function in patients with coronary artery stenosis.GWE can be used as a sensitive indicator to predict patients with severe coronary artery stenosis,and is worth to be popularized and applied in the clinical.