无创左心室压力-应变环在评估冠心病患者心肌做功中的应用

Application of non-invasive left ventricular pressure strain loop in evaluation of myocardial work in patients with coronary atherosclerotic heart disease

目的利用无创左心室压力-应变环(LV-PSL)分析心肌做功(MW)参数在诊断冠心病(CAD)患者冠状动脉狭窄的临床价值。方法选取该院2019年8月至2020年8月可疑CAD患者125例,其中对照组45例(狭窄率<70%),冠状动脉严重狭窄组80例(狭窄率≥70%),并进一步将冠状动脉严重狭窄组分为单支冠状动脉狭窄组43例,多支冠状动脉狭窄组37例。把袖带血压作为左心室压力形成LV-PSL,收集患者动态超声心动图,利用二维斑点追踪技术对整体纵向应变(GLS)进行分析,得到应变达峰时间离散度(PSD),计算并比较各组MW参数[整体做功指数(GWI)、整体有用功(GCW)、整体做功效率(GWE)、整体无用功(GWW)],绘制受试者工作特征(ROC)曲线分析各参数预测CAD患者发生冠状动脉狭窄的效能。结果冠状动脉狭窄组GLS、GWI、GCW、GWE低于对照组,纵向PSD、GWW高于对照组,差异均有统计学意义(P<0.05);单支冠状动脉狭窄组GWI、GCW、GWE低于对照组,GWW高于对照组,差异均有统计学意义(P<0.05),两组GLS无明显差异(P>0.05);多支冠状动脉狭窄组GLS、GWI、GCW、GWE低于对照组和单支冠状动脉狭窄组,GWW高于对照组和多支冠状动脉狭窄组,差异均有统计学意义(P<0.05)。GWI预测CAD患者冠状动脉狭窄的ROC曲线下面积(AUC)为0.765,高于GWE、GCW、GWW(分别为0.758、0.725、0.638),其灵敏度为90%,特异度为70%。结论CAD患者LV-PSL下左心室MW受损,GWI预测冠状动脉狭窄的效能优于GCW、GWE及GWW。

Objective To investigate the clinical value of myocardial work(MW)parameters for diagnosing coronary artery stenosis in the patients with coronary atherosclerotic heart disease(CAD)by using non-invasive left ventricular pressure strain loop(LV-PSL).Methods A total of 125 patients with suspected CAD in this hospital from August 2019 to August 2020 were selected,including 45 cases in the control group(stenosis rate<70%)and 80 cases in the severe coronary artery stenosis group(stenosis rate≥70%).The severe coronary artery stenosis group was further divided into the single-vessel coronary artery stenosis group(43 cases)and the multi-vessel coronary artery stenosis group(37 cases).The cuff blood pressure was used as left ventricular pressure to form a LV-PSL.The dynamic ultrasonic cardiogram was collected,and the global longitudinal strain(GLS)was analysed by using the two-dimensional speckle tracking technology to obtain the longitudinal strain peak time dispersion(PSD).The MW parameters,including global work index(GWI),global constructive work(GCW),global work efficiency(GWE),and global wasted work(GWW),in each group were calculated and compared.The receiver operating characteristic(ROC)curve was drawn to analyze the efficiency of each parameter in predicting the coronary artery stenosis occurrence in CAD patients.Results The values of GLS,GWI,GCW and GWE of the coronary artery stenosis group were lower than those of the control group,and the values of longitudinal P SD and GWW were higher than those of the control group,and the differences were statistically significant(P<0.05).The values of GWI,GCW and GWE of the single-vessel coronary artery stenosis group were lower than those of the control group,the value of GWW was higher than that of the control group,and the differences were statistically significant(P<0.05).There was no significant difference in the value of GLS between the two groups(P>0.05).The values of GLS,GWI,GCW and GWE of the multi-vessel coronary artery stenosis group were lower than those of the control group and single-vessel coronary artery stenosis group,and the value of GWW was higher than that of the control group and multi-vessel coronary artery stenosis group,and the differences were statistically significant(P<0.05).The area under the ROC curve(AUC)of GWI for predicting coronary artery stenosis in CAD patients was 0.765,which was higher than that of GWE,GCW and GWW(0.758,0.725 and 0.638,respectively),with a sensitivity of 90%and a specificity of 70%.Conclusion Left ventricular MW is impaired under LV-PSL in CAD patients,and the efficiency of GWI in predicting coronary artery stenosis is better than that of GCW,GWE and GWW.