超声无创心肌做功技术在冠心病经皮冠状动脉介入治疗前后左室收缩功能中的临床应用

Clinical application of ultrasonic noninvasive myocardial work detection technology in left ventricular systolic function before and after percutaneous coronary intervention forcoronary artery disease

目的 :研究超声无创心肌做功技术在冠心病(Coronary artery disease,CAD)患者经皮冠状动脉介入治疗(Percutaneous coronary intervention,PCI)术前后定量评价左室收缩功能变化中的应用价值。方法:选取CAD行PCI的患者35例作为病例组,25例健康体检者作为对照组,采用MW获得心肌做功指数:整体做功指数(Global work index,GWI)、整体有用功(Global constructive work,GCW)、整体无用功(Global wasted work,GWW)、整体做功效率(Global work efficiency,GWE)、整体纵向应变值(Global longitudinal strain,GLS)和纵向峰值应变离散度(Peak strain time dispersion,PSD),将病例组术前和术后1周、术后1月及术后3月各参数分别与对照组进行比较,随后进行相关性分析。结果:与对照组相比,CAD患者在PCI术前、术后第1周、术后第1月及术后第3月的GLS、GWW及PSD均增高,GWI、GCW及GWE均减低,差异有一定的统计学意义(P<0.05)。CAD患者术后与术前相比,术后1周GWW、PSD显著降低,GWE显著升高,差异具有一定的统计学意义(P<0.05);GWI、GCW及GWE在术后1、3月均增加,同时GLS、GWW及PSD均减低,差异有统计学意义(P<0.05)。术后1、3月与术后1周相比,GWI、GCW及GWE均增加,GLS、GWW及PSD均减低,差异有统计学意义(P<0.05)。术后3月与术后1月相比,GWI、GCW及GWE均增加,GLS、GWW及PSD均减低,差异有统计学意义(P<0.05)。GWI、GCW、GWW、GWE与LVEF、GLS均显著相关,GWE、GWW与PSD相关(P<0.05)。通过Bland-Altman分析,GWI、GCW、GWW及GWE无论在观察者内部还是在观察者之间测量,均具备良好的一致性。结论:无创心肌做功技术可以定量评估CAD患者在PCI前后心功能变化情况,在临床疗效评价中有良好的应用价值。

Objective: To investigate the application value of ultrasonic noninvasive myocardial work detection technology in quantitative evaluation of left ventricular systolic function before and after percutaneous coronary intervention(PCI) in patients with coronary artery disease(CAD). Methods: Thirty-five patients with CAD undergoing PCI were chosen as the case group, and 25 healthy volunteers in the same period were chosen as the control group. The myocardial work parameters included GWI, GCW, GWW, GWE, GLS and PSD were obtained by noninvasive myocardial work detection technology. The differences in myocardial work index between the two groups, including controls, patients before operation, 1-week, 1-month and3-month after operation were compared. The correlation between parameters were analyzed. Results: Compared with the control group, GWI, GCW and GWE in each case groups were decreased before and after PCI, while GLS, GWW and PSD increased significantly(all P <0.05);Compared with the preoperation, GWW and PSD of the postoperation 1-week were decreased and GWE increased significantly(all P<0.05). GWI, GCW and GWE of the postoperation 1-month and 3-month were increased,while GLS, GWW and PSD were decreased(all P<0.05). Compared with the postoperation 1-week, GWI, GCW and GWE were increased of the postoperation 1-month and 3-month, while GLS, GWW and PSD were decreased(all P<0.05). Compared with the postoperation 1-month, GWI, GCW and GWE were increased of the postoperation 3-month, while GLS, GWW and PSD were decreased(all P<0.05). GWI, GCW, GWW and GWE were significantly correlated with left ventricular ejection fraction(LVEF) and global longitudinal strain(GLS). At the same time, GWE and GWW were correlated with PSD(all P<0.05). BlandAltman analysis showed that the measurements of GWI, GCW, GWW and GWE between the observers and within the same observer exhibited good consistency. Conclusion: Noninvasive myocardial work detection technology can quantitatively evaluate the changes of cardiac function in patients with CAD before and after PCI, and has good application value in clinical efficacy evaluation and prognosis judgement.