正常成年人静息及负荷状态下采用超声心动图无创评估心肌做功参数初步探究

The Characteristics and Repeatability of Echocardiographic Myocardial Work Indices in Healthy Adults at Baseline and After Exercise Stress:a Preliminary Study

目的:初步探究正常成年人静息及负荷状态下采用超声心动图新技术——左心室压力应变环(PSL)无创评估心肌做功参数特征且进行重复性检验。方法:纳入2019年7月至12月在中国医学科学院阜外医院体检的健康志愿者64名,平均年龄(51±14)岁,男性占48%。其中38名研究对象(男性占50%)接受平板运动负荷试验。采集并储存被检者静息及负荷状态超声心动图动态图像,运用PSL无创评估心肌做功,进行整体做功指数(GWI)、整体做功效率(GWE)、整体有效做功(GCW),整体无效做功(GWW)分析。结果:静息状态男性GWW值大于女性,GWI、GCW和GWE值小于女性,但差异均无统计学意义(P均>0.05)。总人群负荷状态GWI、GCW、GWW值显著大于静息状态,GWE显著小于静息状态(P均<0.05);男性负荷状态GWI、GCW、GWW值大于静息状态(P均<0.05);女性负荷状态GWI、GCW、GWW值大于静息状态,GWE值小于静息状态(P均<0.05);负荷状态男性GWW值显著低于女性(P<0.05)。GWW、GWI、GCW和GWE值在不同年龄段间差异均无统计学意义(P均>0.05)。组内相关系数和Bland-Altman图显示静息及负荷状态下心肌做功参数在观察者内及观察者间一致性良好。结论:研究初步探究了正常成人静息及负荷状态下PSL无创评估心肌做功参数特征,进一步验证了心肌做功参数具有良好的重复性。

Objectives:To explore the characteristics of noninvasive echocardiographic parameters:myocardial work(MW),based on left ventricular pressure strain loops(PSL)and test the repeatability of MW parameters in normal adults at baseline and after exercise stress.Methods:64 healthy adult volunteers(age[51±14]years;male:48%),who underwent physical examination from July 2019 to December 2019 in Fuwai hospital,were consecutively enrolled;38 subjects(male:50%)underwent treadmill exercise stress.Twodimensional echocardiography was performed in all subjects and the digital loops were recorded and analyzed offline at baseline and after exercise stress.PSL were used to assess MW including global myocardial work index(GWI),global myocardial work efficiency(GWE),global myocardial constructive work(GCW)and global myocardial wasted work(GWW).Results:At baseline,values of GWW tended to be higher and values of GWI,GCW,and GWE tended to be lower in men as compared to women(all P>0.05).After treadmill exercise stress,the values of GWI,GCW and GWW significantly increased while GWE significantly decreased(all P<0.05);the values of GWI,GCW and GWW in men were significantly higher than those at baseline(P<0.05)and the values of GWI,GCW and GWW in women were significantly higher than those at baseline,but GWE was significantly lower than at baseline(all P<0.05);besides,GWW was significantly lower in men than in women(P<0.05).The values of MW indexes were similar among different age groups.Good repeatability in MW indices at baseline and after exercises stress was evidenced by the intra-class correlation coefficients and Bland-Altman plot.Conclusions:The study presents the characteristics of MW indices based on PSLs and demonstrates a good repeatability of MW indices in healthy adults at baseline and after exercise stress.