应用无创性压力-应变环定量评价重度动脉性肺动脉高压患者早期左心室功能

Quantitative evaluation of early left ventricular function in patients with severe arterial pulmonary hypertension using non-invasive pressure strain loops

目的探究左心室压力-应变环(PSL)评价重度动脉性肺动脉高压(sPAH)患者左心室心肌做功及阐明左右心室相互影响的可行性。方法选取2020年11月至2022年4月于内蒙古自治区人民医院就诊的sPAH患者30例(病例组)和健康体检者30例(对照组),采集常规超声心动图数据后进行左心室心肌做功分析,得出参数包括:整体做功指数(GWI)、整体有用功(GCW)、整体无用功(GWW)、整体做功效率(GWE)。比较两组间心肌做功参数的差异,并将心室应变参数及其他常规超声心动图参数进行相关性分析。结果(1)sPAH组与对照组相比,除肺动脉收缩压(PASP)外的一般临床资料差异均无统计学意义(均P>0.05)。(2)sPAH组右心室常规超声心动图参数右心室径(Rv-d)/左心室径(Lv-d)、右室壁厚度、右心室面积变化分数(RVFAC)、三尖瓣瓣环位移(TAPSE)与对照组比较差异均有统计学意义(t=21.305、12.485、12.359、8.095,均P<0.05),左心室常规超声心动图参数左心室舒张期末容积(LVEDV)、心输出量(CO)均小于对照组(t=4.443、2.458,均P<0.05)。(3)sPAH组左心室整体纵向应变(LVGLS)、右心室整体纵向应变(RVGLS)均低于对照组(t=2.927、22.350,均P<0.05)。(4)sPAH组GWI、GCW、GWE低于对照组,GWW高于对照组,差异均有统计学意义(t=8.297、5.520、15.251、11.389,均P<0.05)。(5)sPAH组左心室GWI、GCW、GWE与LVGLS、RVGLS、PASP呈负相关(均P<0.01),与TASPE、RVFAC呈正相关(均P<0.01);GWW与PASP、RVGLS、LVGLS呈正相关(均P<0.01),与RVFAC、TAPSE呈负相关(均P<0.01)。结论PSL能够精准灵敏地反映sPAH患者左心室早期心功能改变和左右心室功能之间相互影响的关系,为临床评估心功能提供了新的参考依据。

Objective To explore the feasibility of using left ventricular pressure-strain loop(PSL)to evaluate left ventricular myocardial work in patients with severe arterial pulmonary hypertension(sPAH)and to elucidate the interaction between left and right ventricles.Methods A total of 30 sPAH patients(case group)and 30 healthy individuals(control group)who received medical examination at Inner Mongolia Autonomous Region People′s Hospital from November 2020 to April 2022 were selected.Routine echocardiography data were collected and left ventricular myocardial work analysis was performed.The parameters obtained included overall work index(GWI),overall useful work(GCW),overall useless work(GWW),and overall work efficiency(GWE).The differences in myocardial work parameters between the two groups were compared,and the correlation analysis between ventricular strain parameters and other conventional echocardiography parameters was performed.Results(1)Compared with the control group,there was no statistically significant difference in general clinical data between the sPAH group except for pulmonary artery systolic pressure(PASP)(all P>0.05).(2)The parameters of right ventricular diameter(Rv-d)/left ventricular diameter(Lv-d),right ventricular wall thickness,right ventricular area change fraction(RVFAC),tricuspid annular displacement(TAPSE)in the sPAH group showed statistically significant differences compared to the control group(t=21.305,12.485,12.359,8.095,all P<0.05).The parameters of left ventricular conventional echocardiography,left ventricular end diastolic volume(LVEDV)The cardiac output(CO)was smaller than that of the control group(t=4.443,2.458,all P<0.05).(3)The overall left ventricular longitudinal strain(LVGLS)and right ventricular longitudinal strain(RVGLS)in the sPAH group were lower than those in the control group(t=2.927,22.350,all P<0.05).(4)The GWI,GCW,and GWE of the sPAH group were lower than those of the control group,while GWW was higher than that of the control group,with statistical significance(t=8.297,5.520,15.251,11.389,all P<0.05).(5)The left ventricular GWI,GCW,and GWE in the sPAH group were negatively correlated with LVGLS,RVGLS,and PASP(all P<0.01),and positively correlated with TASPE and RVFAC(all P<0.01);GWW was positively correlated with PASP,RVGLS,and LVGLS(all P<0.01),and negatively correlated with RVFAC and TAPSE(all P<0.01).Conclusions PSL can accurately and sensitively reflect the relationship between early left ventricular function changes and left and right ventricular function in sPAH patients,providing a new reference for clinical evaluation of cardiac function.