超声心动图左室压力-应变环对冠脉搭桥术患者心肌做功的定量研究

Quantitative evaluation of left ventricular myocardial work by pressure-strain loops using echocardiography in patients undergoing coronary artery bypass grafting

目的应用超声心动图左室压力-应变环(PSL)定量评价冠脉搭桥术(CABG)患者心肌做功指数的变化。方法选取2018年10月至2019年5月在河南省人民医院拟行CABG的患者30例为病例组,选取同期健康体检者30例作为对照组,应用左室PSL评估左室心肌做功指数,包括整体做功指数(GWI)、整体有用功(GCW)、整体无用功(GWW)、整体做功效率(GWE),比较对照组与病例组术前、术后1个月、术后3个月心肌做功指数的差异。结果与对照组相比,病例组术前、术后1个月及术后3个月GWI、GCW、GWE降低,GWW升高,差异均有统计学意义(P<0.05)。与术前相比,术后1个月GWI、GCW、GWW、GWE无明显变化(P>0.05),术后3个月GWI、GWE增高,差异均有统计学意义(P<0.05)。与术后1个月相比,术后3个月GWI、GCW、GWE增高,差异均有统计学意义(P<0.05)。GWI、GCW、GWW、GWE与左室射血分数及整体纵向应变均显著相关(P=0.00)。Bland-Altman分析结果显示,观察者内部及观察者之间测量GWI、GCW、GWW及GWE一致性良好。结论左室PSL可定量评估CABG患者的心肌做功,为CABG患者左室收缩功能的定量评估提供了一种新方法。

Objective To quantitatively evaluate the changes of left ventricular myocardial work indices by pressure-strain loops(PSL)using echocardiography in patients undergoing coronary artery bypass grafting(CABG).Methods Thirty patients undergoing CABG from October 2018 to May 2019 in Henan Provincial People′s Hospital were chosen as the case group,and 30 healthy subjects were selected as the control group.The myocardial work indices of left ventricle,including global work index(GWI),global constructive work(GCW),global work waste(GWW)and global work efficiency(GWE)were measured by PSL,the differences in myocardial work indices between the two groups,including controls,patients before surgery,1 month,and 3 months after CABG were compared.Results Compared with the control group,GWI,GCW,GWE of the left ventricle in each case groups were decreased before and after CABG,while GWW was increased significantly(all P<0.05);Compared with the preoperation,GWI,GCW,GWW,GWE of left ventricle of the postoperative 1-month were decreased,but the differences were not statistically significant(all P>0.05),while GWI,GWE of left ventricle of the postoperative 3-month were increased,and the differences were statistically significant(all P<0.05);the differences of GWI,GCW,GWE between the postoperative 1-month and 3-month were statistically significant(all P<0.05).GWI,GCW,GWW,GWE were significantly related to left ventricular ejection fraction(LVEF)or global longitudinal strain(GLS)(all P=0.00).Bland-Altman drawing plots showed that the measurements of GWI,GCW,GWW,GWE between the observers and within the same observer exhibited good reproducibility.Conclusions PSL can quantitatively evaluate left ventricular myocardial work and provide a new method for the evaluation of left ventricular systolic function in patients undergoing CABG.