心肌做功评估冠脉微循环功能障碍患者左心室功能

Evaluation of Left Ventricular Function in Patients with Coronary Micro-Vascular Dysfunction by Myocardial Work

应用腺苷负荷超声心动图及心肌做功参数评估冠脉微循环功能障碍患者左心室功能的改变规律.选取冠状动脉微循环功能障碍的患者110例,分为冠脉狭窄<50%、冠脉狭窄50%~75%及冠脉狭窄>75%组,健康体检者30例为对照组,评估患者腺苷负荷超声心动图检查心肌做功参数的变化规律.结果表明:1)冠状动脉微循环功能障碍患者可能已经出现亚临床损害,表现为左室局部心肌力学改变,可被腺苷负荷超声心动图检出.若同时伴有心外膜动脉狭窄时,随着心外膜动脉狭窄程度增大,逐渐引起心脏器质性改变,并引起腺苷负荷超声心动图中心肌做功参数不同程度的改变.2)当冠状动脉微循环功能障碍患者心外膜动脉狭窄<50%时,负荷后心肌做功参数中峰值应变离散度(PSD)及整体无用功(GWW)增大.当狭窄超过50%时,负荷后额外出现了整体做功效率(GWE)降低;而当狭窄超过75%,基础及负荷状态下的心肌做功参数均受损,负荷后PSD、GWW反而较基础状态下减小.应用腺苷负荷超声心动图及心肌做功参数可以定量评估不同冠脉狭窄程度的冠脉微循环功能障碍患者左心室功能,通过比较患者基础及负荷状态下差异,可以预估患者的病变严重程度,具有良好的重复性和稳定性,可以为临床诊断和疗效评估提供帮助.

To evaluate the changes of left ventricular function in patients with coronary micro-vascular dysfunc-tion by adenosine stress echocardiography and Myocardial work,110 patients with coronary micro-vascular dys-function were divided into coronary stenosis<50%group,50%-75%coronary stenosis group,and coronarystenosis>75%group.30 healthy physical examining personnel served as normal control group.The changes of leftventricular function were analyzed by adenosine stress echocardiography and Myocardial work.The results show:1)Patients with coronary micro-vascular dysfunction may already have subclinical damage,manifested as chan-ges in left ventricular regional myocardial mechanics that can be detected by adenosine stress echocardiography.If there is concomitant epicardial artery stenosis,as the degree of epicardial artery stenosis increases,it gradually causes organic changes in the heart and changes the myocardial work parameters in adenosine stress echocardio-graphy to varying degrees.2)When the epicardial artery stenosis in CMD patients is less than 50%,the PSD(Peak Strain Dispersion)and GWW(Global Wasted Work)myocardial work parameters increase after stressed.When the stenosis exceeds 50%,there is an additional decrease in GWE(global work efficiency)ater stressed;when the stenosis exceeds 75%,both basic and stressedmyocardial work parameters are damaged,and PSD andGWW decrease after stressed compared to basic conditions.Adenosine stress echocardiography and myocardialwork can be used to quantitatively evaluate the left ventricular function of patients with coronary micro-vasculardysfunction complicated by different degrees of coronary stenosis.By comparing the differences between patientsat rest and after stressed,the severity of the disease can be estimated.And they can provide help for clinical di-agnosis and efficacy evaluation with good repeatability and stability.