整体纵向应变和机械离散度对心力衰竭患者室性心动过速的预测价值

Predictive value of global longitudinal strain and mechanical dispersion for ventricular tachycardia in patients with heart failure

目的探讨基于二维斑点追踪的左心室整体纵向应变(GLS)、机械离散度(MD)以及GLS/MD对心力衰竭(HF)患者发生室性心动过速(VT)的预测价值。方法回顾性选取2021年7月至2022年1月于哈尔滨医科大学附属第一医院心内科住院的99例左心室射血分数(LVEF)<50%的HF患者,依据24 h动态心电图结果,将患者分为VT组(25例)和无VT组(74例)。比较两组基线资料和超声心动图参数,多因素logistic回归分析影响VT发生的独立预测因素。结果VT组患者的收缩压、舒张压、脉压均显著低于无VT组,差异有统计学意义(均为P<0.05)。此外,与无VT组相比,VT组的左心房前后径、左心室舒张末内径、GLS、MD、GLS/MD值较高,而LVEF较低,差异均有统计学意义(均为P<0.01)。多因素logistic回归分析显示,左心室舒张末期内径(OR=1.194,95%CI:1.024~1.468,P=0.045)、GLS/MD(OR=2.695,95%CI:1.709~6.195,P=0.002)是HF患者发生VT的独立危险因素。结论左心室舒张末期内径、GLS/MD是HF患者发生VT的独立预测因素,且GLS/MD的预测价值更高。

Objective To explore the predictive value of global longitudinal strain(GLS),mechanical dispersion(MD),and GLS/MD based on two-dimensional speckle tracking for the occurrence of ventricular tachycardia(VT)in patients with heart failure(HF).Methods A retrospective analysis was conducted on 99 HF patients with left ventricular ejection fraction(LVEF)<50%who were admitted to the Department of Cardiology,the First Affiliated Hospital of Harbin Medical University,from July 2021 to January 2022.Based on the results of 24-hour dynamic electrocardiography,the patients were divided into the VT group(25 cases)and the non-VT group(74 cases).Baseline data and echocardiographic parameters were compared between the two groups,and multivariate logistic regression analysis was performed to identify independent predictive factors for VT occurrence.Results The systolic blood pressure,diastolic blood pressure,and pulse pressure of patients in the VT group were significantly lower than those in the non-VT group,with statistically significant differences(all P<0.05).In addition,compared with the non-VT group,the VT group had higher left atrial anteroposterior diameter,left ventricular end-diastolic diameter,GLS,MD,and GLS/MD values,and lower LVEF,with statistically significant differences(all P<0.01).Multivariate logistic regression analysis showed that left ventricular end-diastolic diameter(OR=1.194,95%CI:1.024-1.468,P=0.045)and GLS/MD(OR=2.695,95%CI:1.709-6.195,P=0.002)were independent risk factors for VT occurrence in HF patients.Conclusions Left ventricular end-diastolic diameter and GLS/MD are independent predictive factors for VT occurrence in HF patients,and GLS/MD has higher predictive value.