二维斑点追踪超声心动图评估增强型体外反搏对老年冠状动脉慢血流患者左心室功能的影响

Two-dimensional speckle tracking echocardiography for evaluating the effect of enhanced external counterpulsation on left ventricular function in elderly patients with coronary slow flow phenomenon

目的分析二维斑点追踪超声心动图(2D-STE)评估增强型体外反搏(EECP)对老年冠状动脉慢血流(CSF)患者左心室功能的影响。方法前瞻性病例对照研究,纳入2017年12月至2018年12月在山东大学齐鲁医院老年医学科就诊的年龄≥60岁冠状动脉无狭窄性病变但存在≥1条主要冠状动脉慢血流现象30例患者,数字抽签法分为药物治疗组16例,药物联合EECP治疗组(联合治疗组)14例。联合治疗组患者在改善生活方式和药物治疗基础上接受为期6周36 h的EECP治疗。同时纳入冠状动脉血流正常患者14例为对照组。采用常规超声心动图和2D-STE评价CSF患者在药物及EECP治疗前、后左心室功能变化。结果治疗前与对照组比较,药物治疗组和联合治疗组患者二尖瓣环舒张早期运动速度下降(P<0.01),二尖瓣舒张早期峰值血流速度与二尖瓣环舒张早期峰值速度平均值比值增大(P<0.05),左心室收缩期纵向应变(P<0.01)、收缩期纵向应变率(P<0.01)及舒张早期纵向应变率均减低(P<0.01)。CSF患者药物治疗组常规超声心动图参数治疗前、后比较差异无统计学意义(均P>0.05)。联合治疗组治疗前、后室间隔舒张早期运动速度(6.22±0.64)cm/s比(6.69±0.44)cm/s、侧壁舒张早期运动速度(8.01±0.68)cm/s比(8.41±0.29)cm/s、二尖瓣舒张早期峰值血流速度与二尖瓣环舒张早期峰值速度平均值(10.51±1.38)比(9.74±0.37)、左心室收缩期纵向应变(-16.21±0.46)%比(-16.80±0.48)%、收缩期纵向应变率(-1.29±0.03)s-1比(-1.35±0.04)s-1、舒张早期纵向应变率(1.35±0.03)s-1比(1.40±0.03)s-1,差异有统计学意义(t值分别为-3.70、-2.74、2.23、10.25、12.30、-19.15,均P<0.05)。结论2D-STE可以早期、定量地评价老年CSF患者亚临床心肌功能障碍,客观反映EECP临床干预前后左心室功能改变。EECP治疗可改善CSF患者亚临床左心功能障碍。

Objective This study aimed to evaluate the effect of enhanced external counterpulsation(EECP)on left ventricular function in elderly patients with coronary slow flow phenomenon(CSFP)using two-dimensional speckle tracking echocardiography(2D-STE).Methods This prospective case-control study included 30 patients aged≥60 years with no stenotic lesions in the coronary arteries but with slow blood flow phenomenon in more than one major coronary artery who were treated at the Department of Geriatrics,Qilu Hospital,Shandong University,between December 2017 and December 2018,and were divided into a medication group with 16 participants and a medication plus EECP group with 14 participants,using the numerical lottery method.Patients in the group treated with EECP received 6-week 36-h EECP therapy in addition to lifestyle modification and drug treatment.Fourteen patients with normal coronary blood flow served as the control group.Conventional echocardiography and 2D-STE were used to evaluate changes in left ventricular function in the CSF patients before and after drug treatment and EECP.Results Compared with the control group before treatment,patients in the drug treatment group and the drug treatment plus EECP group showed a decrease in mitral annular early diastolic velocity(P<0.01),an increase in the ratio of peak mitral early diastolic blood flow velocity to the mean peak mitral annular early diastolic velocity(P<0.05),and a decrease in left ventricular longitudinal strain during systole(P<0.01),the longitudinal systolic myocardial strain rate(P<0.01)and the early diastolic longitudinal peak strain rate(P<0.01).There was no statistically significant difference in values from conventional echocardiographic parameters before and after treatment in CSF patients of the medication group(all P>0.05).In the group receiving EECP,there were statistically significant differences in pre-and post-treatment values in ventricular septal early diastolic velocity[(6.22±0.64)cm/s vs.(6.69±0.44)cm/s],lateral wall early diastolic velocity[(8.01±0.68)cm/s vs.(8.41±0.29)cm/s],mitral valve to mitral annulus early diastolic peak velocity ratio[(10.51±1.38)vs.(9.74±0.37)],longitudinal left ventricular systolic strain[(-16.21±0.46)%vs.(-16.80±0.48)%],left ventricular systolic longitudinal strain rate[(-1.29±0.03)s-1vs.(-1.35±0.04)s-1],and early diastolic longitudinal strain rate[(1.35±0.03)s-1vs.(1.40±0.03)s-1](t-values were-3.70、-2.74、2.23、10.25、12.30、-19.15,all P<0.05).Conclusions 2D-STE can evaluate subclinical myocardial dysfunction early and quantitatively in elderly patients with CSF,and objectively reflect changes in left ventricular function before and after clinical intervention with EECP.