超声左心室压力-应变环评价肥厚型心肌病

Ultrasonic left ventricular pressure strain loop for observation on hypertrophic cardiomyopathy

目的观察超声左心室压力-应变环(PSL)评价肥厚型心肌病(HCM)患者左心室收缩功能的价值,评价心肌做功(MW)参数与常规舒张收缩功能、左心室应变参数间的相关性。方法纳入43例HCM患者(HCM组)与49名健康志愿者(对照组),比较组间常规超声参数、应变参数和MW参数。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评价各参数诊断HCM的效能。采用Pearson或Spearman相关分析评估常规超声参数、应变参数与MW参数间的相关性,以多元线性回归分析与MW独立相关的参数。结果HCM组室间隔舒张末期厚度(IVSD)、左心室后壁舒张末期厚度(LVPWD)、左心房前后径(LAD)、容积指数(LAVI)、A峰流速、E/A、E/e'、左心室心内膜下心肌圆周应变(CS-Endo)、左心室整体扭转应变(Twist)、峰值应变离散度(PSD)及整体无效功(GWW)均明显高于对照组(P均<0.05),舒张早期二尖瓣环侧壁(Lateral e')、室间隔运动速度(Septal e')、e'、左心室舒张末期容积(LVEDV)、收缩末期容积(LVESV)、左心室中层心肌(CS-Mid)、心外膜下心肌圆周应变(CS-Epi)、左心室整体纵向及分层应变、整体做功指数(GWI)、整体做功效率(GWE)均明显低于对照组(P均<0.05)。MW指标、左心室整体纵向应变(LVGLS)及PSD诊断HCM的效能均较高(AUC均>0.80)。对照组MW参数与传统收缩舒张功能参数、LVGLS及PSD多呈中度相关,且具有独立相关性(P均<0.05);HCM组不同方向整体和分层应变、PSD及A峰流速均多与MW参数呈低度及以上相关,且具有独立相关性(P均<0.05)。结论超声PSL技术可无创评估HCM患者左心室收缩功能;MW参数与常规舒张收缩功能、左心室应变参数具有一定相关性。

Objective To observe the value of left ventricular pressure strain loop(PSL)technique for evaluation on left ventricular systolic function in patients with hypertrophic cardiomyopathy(HCM),and to evaluate the correlations of myocardial work(MW)parameters with routine diastolic systolic function and left ventricular strain parameters.Methods A total of 43 patients with HCM(HCM group)and 49 healthy volunteers(control group)were enrolled.Conventional ultrasound parameters,strain parameters and MW parameters were obtained and compared between groups.The receiver operating characteristic(ROC)curve was drawn,and the area under the curve(AUC)was calculated to evaluate the effectiveness of parameters for diagnosing HCM.Pearson or Spearman correlation analysis was performed to evaluate the correlation of conventional ultrasonic parameters,strain parameters and MW parameters.Multiple linear regression analysis was used to screen parameters independently related to MW.Results Interventricular septum thickness at end-diastolic(IVSD),left ventricular posterior wall thickness at end-diastolic(LVPWD),left atrial diameter(LAD),left atrial volume index(LAVI),the A peak flow rate,E/A,E/e',left ventricular circumferential strain in subendocardial myocardium(CS-Endo),left ventricular global torsion strain(Twist),peak strain dispersion(PSD)and global wasted work(GWW)in HCM group were significantly higher than those in control group(all P<0.05),while early diastolic mitral annulus Lateral wall(Lateral e')and ventricular Septal velocity(Septal e'),e'flow rate,left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular circumferential strain in middle myocardium(CS-Mid),circumferential strain in subepicardial myocardium(CS-Epi),left ventricular global and layered longitudinal strain,global work index(GWI)and global work efficiency(GWE)in HCM group were all significantly lower than those in control group(all P<0.05).MW parameters left ventricular global longitudinal strain(LVGLS)and PSD were highly effective for diagnosing HCM(all AUC>0.80).In control group,MW parameters were moderately correlated with traditional systolic and diastolic function parameters,LVGLS and PSD,and all had independent correlations(all P<0.05).In HCM group,the global and layered strain in different directions,PSD and A peak flow rate were low or moderately correlated with MW parameters,also had independent correlations(all P<0.05).Conclusion Ultrasonic PSL technique could noninvasively assess left ventricular systolic function of HCM patients.MW parameters were correlated with traditional diastolic and systolic function parameters as well as left ventricular strain parameters.