心脏超声三维空间面积应变参数预测冠心病PCI术后左室收缩功能的临床研究

Clinical study of three-dimensional echocardiography spatial-area strain parameters in predicting left ventricular systolic function in coronary heart disease after PCI

目的:探讨心脏超声三维空间面积应变参数对冠心病(CHD)患者经皮冠状动脉介入治疗(PCI)术后左室收缩功能的预测效能。方法:回顾性分析在我院就诊的112例行PCI治疗的CHD患者(CHD组)及同期67例健康体检者(健康对照组)的临床资料。CHD组又根据左室收缩功能情况分为:左室收缩功能轻度障碍组(LVEF 41%~49%,40例)、中度障碍组(LVEF 31%~40%,37例)和重度障碍组(LVEF≤30%,35例),比较各组手术前后心肌应变指标及LVEF的变化,并分析心肌应变相关指标与LVEF的相关性。结果:与健康对照组比较,CHD组面积应变不同步指数(ASDI)显著升高、整体面积应变(GAS)、左心室整体长轴应变(GLS)和LVEF水平均显著降低(P均=0.001);无论术前还是术后随着CHD患者左室收缩功能障碍程度的加重,其ASDI均显著升高,GAS和GLS均显著降低(P均=0.001);且与术前比较,术后CHD各亚组患者ASDI均显著降低,GAS、GLS和LVEF均显著提高(P均=0.001);Pearson相关分析显示,ASDI与LVEF呈显著负相关(r=-0.797,P=0.001),GAS、GLS与LVEF呈显著正相关(r=0.816,0.815,P均=0.001)。结论:心脏超声三维空间面积参数早期检测对评估术后左心室收缩功能具有重要意义。

Objective:To investigate the predictive efficacy of three-dimensional echocardiography spatial-area strain parameters for left ventricular systolic function(LVSF)in patients with coronary heart disease(CHD)after PCI.Methods:Clinical data of 112 CHD patients underwent PCI in our hospital(CHD group)and simultaneous 67 healthy subjects underwent physical examination(healthy control group)were retrospectively analyzed.According to LVSF,CHD group was further divided into LVSF mild disorder group(LVEF 41%~49%,n=40),moderate disorder group(LVEF 31%~40%,n=37)and severe disorder group(LVEF≤30%,n=35).Myocardial strain indexes and LVEF were compared among above groups before and after PCI,and correlation between LVEF and myocardial strain indexes was analyzed.Results:Compared with healthy control group,there was significant rise in area strain dyssynchrony index(ASDI),and significant reductions in global area strain(GAS),left ventricular global longitudinal strain(GLS)and LVEF in CHD group,P=0.001 all;no matter before or after PCI,as LVSF disorder aggravates,ASDI gradually significantly rose,and GAS and GLS gradually significantly reduced in CHD patients,P=0.001 all.Compared with before PCI,there was significant reduction in ASDI,and significant rise in GAS,GLS and LVEF in all subgroups of CHD after PCI,P=0.001 all.Pearson correlation analysis indicated that ASDI was significant inversely correlated with LVEF(r=-0.797,P=0.001),and GAS,GLS were significant positively correlated with LVEF(r=0.816,0.815,P=0.001 both).Conclusion:Early detection of three-dimensional echocardiographic spatial-area parameters is of great significance for evaluating postoperative left ventricular systolic function.