应用左心室压力-应变环评估高血压患者心肌做功变化的研究

Changes of myocardial work evaluated by left ventricular pressure-strain loop in hypertensive patients

目的应用左心室压力-应变环评估高血压患者心肌做功的变化。方法选择2020年3月至2021年7月于衢州市中医医院就诊的高血压患者115例为观察组,根据高血压情况将患者分为Ⅰ级亚组37例、Ⅱ级亚组51例、Ⅲ级亚组27例。另择同期本院健康体检者50名作为对照组。均行超声心动图检查,测量左心室舒张末期内径(LVEDd)、左心房前后径(LAD)、二尖瓣舒张早期血流峰速(E)、左心室射血分数(LVEF),测量心肌做功参数,包括整体无用功(GWW)、整体做功效率(GWE)、整体做功指数(GWI)、整体有用功(GCW)。采用Pearson相关分析心肌做功参数与左心室整体纵向应变(GLS)的关系,采用Spearman秩相关分析心肌做功参数与高血压分级的关系。结果观察组LVEDd、LAD、GWW、GLS值高于对照组,LVEF、GWE、GWI、GCW低于对照组,差异均有统计学意义(均P<0.05)。GWW与GLS呈正相关(r=0.470,P<0.05),GWE、GWI、GCW与GLS呈负相关(r=-0.563、-0.614、-0.620,均P<0.05)。Ⅰ级亚组、Ⅱ级亚组GWW值低于Ⅲ级亚组,GWE、GWI、GCW值高于Ⅲ级亚组,Ⅰ级亚组GWW值低于Ⅱ级亚组,GWE、GWI、GCW值高于Ⅱ级亚组,差异均有统计学意义(均P<0.05)。Spearman秩相关结果显示,GWW与高血压分级呈正相关(rs=0.467,P<0.05),GWE、GWI、GCW与高血压分级呈负相关(rs=-0.423、-0.535、-0.469,均P<0.05)。结论左心室压力-应变环有助于早期评估高血压患者心肌功能障碍。

Objective To evaluate myocardial work using left ventricular pressure-strain loop in hypertensive patients.Methods A total of 115 hypertensive patients treated in our hospital from March 2020 to July 2021 were selected as observation group and divided into stage 1 group(37 cases),stage 2 group(51 cases)and stage 3 group(27 cases)based on classification of hypertension.Fifty healthy people were selected as control group.All subjects underwent echocardiography.Echocardiographic parameters and myocardial work indices including global wasted work(GWW),global work efficiency(GWE),global work index(GWI)and global constructive work(GCW)were measured.Pearson correlation was used to analyze the relationship between myocardial work indices and global longitudinal strain(GLS).Spearman correlation was used to analyze the relationship between myocardial work parameters and hypertension stage.Results Left ventricular end-diastolic diameter,left atrial diameter,GWW and GLS were significantly higher,and left ventricular ejection fraction,GWE,GWI and GCW were significantly lower in the observation group than in the control group(all P<0.05).GWW was positively correlated with GLS(r=0.470,P<0.05).GWE,GWI and GCW were negatively correlated with GLS(r=-0.563,-0.614,-0.620,all P<0.05).GWW was significantly lower,GWE,GWI and GCW were significantly higher in stage 1 and stage 2 groups than in stage 3 group(all P<0.05).GWW was significantly lower,GWE,GWI and GCW were significantly higher in stage 1 group than in stage 2 group(all P<0.05).GWE,GWI and GCW were significantly higher in stage 1 and stage 2 groups than in stage 3 group(all P<0.05),and were significantly higher in stage 1 group than in stage 2 group(P<0.05).Spearman correlation analysis showed that GWW was positively correlated with hypertension grade(rs=0.467,P<0.05),GWE,GWI and GCW were negatively correlated with hypertension grade(rs=-0.423,-0.535,-0.469,all P<0.05).Conclusion Left ventricular pressure-strain loop is helpful for the early evaluation of myocardial dysfunction.