左室压力-应变环对冠心病患者心肌做功评价的初步研究

Preliminary study on myocardial work evaluation in patients with coronary heart disease by left ventricular pressure strain loop

目的应用左室压力-应变环(LVPSL)评价冠状动脉狭窄患者心肌做功的改变情况,探讨心肌做功参数在诊断冠心病中的临床价值。方法疑诊冠心病患者111例,根据冠脉造影结果分为两组:对照组(冠脉无狭窄或狭窄<50%)33例;冠心病组(至少一支冠脉狭窄≥50%)78例,将冠心病组分为有节段性室壁运动异常组26例,无节段性室壁运动异常组52例;分别采集心尖四腔、两腔、左室长轴切面动态图像,应用Echo PAC工作站获取左室整体纵向应变(GLS),进入心肌做功分析模式,得出LVPSL,最终获取长轴整体做功指数(GWI)、整体有效功(GCW)、整体无效功(GWW)、整体做功效率(GME)。结果与对照组相比,冠心病组GLS、GWI、GCW、GME均显著减低,GWW显著升高(均P<0.01),冠心病有节段性室壁运动异常组GLS、GWW显著升高(P<0.01),冠心病无节段性室壁运动异常组GWI、GCW、GME均显著减低(P<0.01),GLS显著减低、GWW显著升高(P<0.01)。ROC曲线显示GWI、GCW、GWW、GME的曲线下面积分别为0.36、0.40、0.75、0.27;GWW截断值为70.5%,预测冠心病的灵敏度、特异度分别为67%、97%,约登指数0.64。结论LVPSL可量化分析冠心病患者心肌做功,其中GWW是反映冠心病患者心肌做功和心室功能改变的较敏感指标。

AIM To evaluate changes in myocardial work in patients with coronary artery stenosis by left ventricular pressure strain loop(LV PSL)and to explore the clinical value of myocardial work parameters in the diagnosis of coronary heart disease.METHODS One hundred and eleven patients with suspected coronary heart disease were divided into two groups according to their coronary angiography results:a control group(33 patients without coronary artery stenosis or stenosis<50%)and 78 patients in a coronary heart disease(CHD)group(at least one coronary artery stenosis≥50%),who were subdivided into a CHD group with regional wall motion abnormality(26 patients)and a CHD group without regional wall motion abnormality(52 patients).Dynamic images of the apical four-chamber,two-chamber and left ventricular long-axis sections were collected,using Echo PAC workstation for whole left ventricular global longitudinal strain(GLS),entering the myocardial work(MW)analysis model,and eventually getting global MW index(GWI),constructive MW(GCW),wasted MW(GWW)and MW efficiency(GME).RESULTS Compared with those in control group,GLS,GWI,GCW and GME in CHD group all decreased and GWW increased(P<0.05).GLS and GWW increased in CHD group with regional wall motion abnormality(P<0.05).GWI,GCW and GME decreased(P>0.05),and GLS decreased and GWW increased(P<0.05)in CHD group without regional wall motion abnormality.The ROC curve showed that the area under the curve of GWI,GCW,GWW and GME was 0.36,0.40,0.75 and 0.27 respectively.The cut-off GWW value was 70.5%,the sensitivity and specificity of predicting coronary heart disease were respectively 67%and 97%,and the Youden index was 0.64.CONCLUSION Left ventricular pressure strain loop is able to quantitatively analyze myocardial work in patients with coronary heart disease.GWW is a more sensitive indicator of myocardial work and ventricular function changes in patients with coronary heart disease.