斑点追踪分层应变联合心肌做功技术评价射血分数保留的心力衰竭患者左心室功能

Assessment of left ventricular function in heart failure with preserved ejection fraction patients by speckle tracking layer-specific strain combined with myocardial work technique

目的应用斑点追踪分层应变联合心肌做功技术评价射血分数保留的心力衰竭(HFpEF)患者左室收缩功能及整体心肌做功变化,探讨各参数对HFpEF的诊断性能。方法选取2019年12月至2020年12月于哈尔滨医科大学附属第四医院确诊的38例HFpEF患者(HFpEF组)以及性别、年龄与之匹配的38例体检健康者(对照组)。采集常规超声参数,应用分层应变和心肌做功技术分别获取左室心内膜下层、心肌中层和心外膜下层整体纵向应变(GLSendo、GLSmid、GLSepi)及整体心肌做功指数(GWI)、整体做功效率(GWE)、整体有效功(GCW)、整体无效功(GWW)指标,计算整体纵向应变跨壁阶差(ΔGLS),分析两组间参数的差异。绘制ROC曲线,比较分层应变及心肌做功参数对HFpEF患者左室收缩功能的预测价值。结果①HFpEF组左房内径、室间隔厚度、左室后壁厚度、相对室壁厚度、左室质量指数、平均舒张早期二尖瓣口峰值流速(E)/舒张早期二尖瓣环运动速度(e′)大于对照组,舒张晚期二尖瓣口峰值流速(A)、E/A、e′小于对照组,差异有统计学意义(均P<0.05);两组E、左室舒张末期内径、左室舒张末期容积、左室收缩末期容积、短轴缩短率及左室射血分数差异无统计学意义(均P>0.05)。②HFpEF组和对照组GLSendo、GLSmid、GLSepi由内向外依次递减的跨壁梯度仍然存在。③HFpEF组GLSendo、GLSmid、GLSepi、ΔGLS、GWE、GWI、GCW低于对照组,GWW增高,差异有统计学意义(均P<0.01)。④ROC曲线显示,ΔGLS、GWE预测HFpEF患者左室收缩功能受损曲线下面积(AUC)相对较大,分别为0.884、0.882,最佳截断值为-5.8%、95%,敏感性为84.2%、71.1%,特异性为84.2%、89.5%。⑤两种技术联合诊断的ROC曲线显示,ΔGLS联合GWE的AUC最大为0.944,敏感性81.6%,特异性97.4%。结论斑点追踪分层应变和心肌做功技术均能早期敏感检测HFpEF患者左心室心肌功能损害;ΔGLS、GWE是预测HFpEF患者左室收缩功能受损更可靠的指标,两种技术联合可提升对HFpEF的诊断性能。

Objective To assess the changes of left ventricular systolic function and global myocardial work in heart failure with preserved ejection fraction(HFpEF)patients by speckle tracking layer-specific strain combined with myocardial work technique and explore the diagnostic value of each parameter for HFpEF.Methods From December 2019 to December 2020,38 HFpEF patients(HFpEF group)and 38 healthy individuals with age-and sex-matched(control group)were enrolled consecutively in the Fourth Affiliated Hospital of Harbin Medical University.Conventional ultrasound parameters were collected.Layer-specific strain and myocardial work techniques were used to obtain the global longitudinal strain(GLS)of the left ventricular endocardium,mid-myocardium,and epicardium(GLSendo,GLSmid,GLSepi),global myocardial work index(GWI),global myocardial work efficiency(GWE),global constructive work(GCW),and global wasted work(GWW).The absolute difference of GLS(ΔGLS)between endocardium and epicardium were calculate.All parameters were analyzed statistically.ROC curves were plotted to compare the effectiveness of layer-specific strain and myocardial work parameters in predicting left ventricular systolic function impairment in HFpEF patients.Results①Left atrial diameter,interventricular septum at end-diastole,left ventricular posterior wall at end-diastole,relative wall thickness,left ventricular mass index,and average early diastolic peak velocity(E)/early diastolic tissue velocity(e′)in HFpEF group were significantly higher compared with control subjects,while late diastolic peak velocity(A),E/A,and e′were significantly lower(all P<0.05);E,left ventricular end-diastolic diameter,left ventricular end-diastolic volume,left ventricular end-systolic volume,fraction shortening,and left ventricular ejection fraction were not different between HFpEF and control groups(all P>0.05).②The global longitudinal strain of the left ventricule was highest in the endocardium and lowest in the epicardium.③Compared with control subjects,HFpEF patients demonstrated significantly decreased GLSendo,GLSmid,GLSepi,ΔGLS,GWI,GWE,GCW and increased GWW(all P<0.01).④The ROC results showed that the area under the curve ofΔGLS and GWE for predicting left ventricular contractile function impairment in HFpEF group,was 0.884 and 0.882,respectively;The cutoff values were-5.8%and 95%;The sensitivity were 84.2%and 71.1%,and the specificity was 84.2%and 89.5%,respectively.⑤The ROC curve of combining the two technologies showed that the maximum area under the curve of theΔGLS in tandem with GWE was 0.944,the sensitivity was 81.6%,and the specificity was 97.4%.Conclusions Both speckle tracking layer-specific strain and myocardial work techniques can sensitively detect left ventricular myocardial function impairment in HFpEF patients at an early stage.ΔGLS and GWE are more reliable indexes for predicting left ventricular systolic function damage in HFpEF patients.Combining the two techniques can improve the diagnostic performance in HFpEF patients.