无创左心室心肌做功技术在非心肌梗死冠心病患者诊断中的应用研究

Application of noninvasive left ventricular myocardial work technology in the diagnosis of coronary heart disease with⁃ out myocardial infarction

目的 探讨无创左心室心肌做功技术(left ventricular myocardial work,LVMW)在非心肌梗死冠心病诊断中的应用价值。方法 选取我院心血管内科门诊就诊的既往有疑似缺血性胸痛发作病史的非心肌梗死患者109例,均行常规超声心动图检查并进行LVMW分析,具有完整的冠状动脉造影资料。以冠状动脉造影结果为金标准分为无冠状动脉狭窄组40例,单支病变组40例,多支病变组29例,比较各组常规超声参数及心肌做功参数的差异,评价LVMW各参数对冠状动脉狭窄的预测价值。结果 单支、多支病变组较无狭窄组左心室整体做功指数(GWI)、整体有效做功(GCW)、整体做功效率(GWE)均减低,差异有统计学意义(P<0.05),整体无效做功(GWW)增高,差异有统计学意义(P<0.05);单支病变组较无狭窄组左心室整体长轴应变值(GLS)减低、达峰时间离散指数(PSD)增高,差异无统计学意义(P>0.05),多支病变组较无狭窄组GLS减低、PSD增高,差异有统计学意义(P<0.05);多支病变组较单支病变组GLS、GWI、GCW、GWE均减低,差异有统计学意义(P<0.05),PSD、GWW均增高,差异有统计学意义(P<0.05)。GWI、GWE、GCW、GWW均具有一定早期预测冠状动脉狭窄的能力(P<0.05),其中GWI预测冠状动脉狭窄(至少一支心外膜下冠状动脉直径狭窄率≥70%)的灵敏度最佳,阳性似然比最大,阴性似然比最小。结论 非心肌梗死冠心病患者左心室心肌做功参数发生改变,GWI可以作为新的无创指标为超声心动图筛查非心肌梗死冠心病提供新的参考方向。

Objective To evaluate the application value of left ventricular myocardial work(LVMW)technology in the diag⁃nosis of coronary heart disease without myocardial infarction.Methods 109 non-myocardial infarction patients with suspected history of ischemic chest pain attack were collected in the cardiovascular department of our hospital for this study.All patients un⁃derwent transthoracic echocardiography and LVMW analysis,with complete coronary angiography(CAG)data.The subjects were divided into non coronary artery stenosis group(40 cases),single-vessel coronary artery stenosis group(40 cases),and multi-vessel coronary artery stenosis group(29 cases)according to the results of CAG.The differences of transthoracic echocar⁃diography parameters and LVMW parameters in each group were compared.The predictive value of LVMW parameters on coro⁃nary stenosis was evaluated.Results GWI,GCW and GWE in coronary artery stenosis group were lower than those in matched group,while,GWW was higher than that in matched group(all P<0.05).Compared to the matched group,the changes in GLS and PSD were not significant in the single coronary artery stenosis group,but,they had significant difference in the multiple coronary artery stenosis group.GLS,GWI,GCW and GWE in the multiple coronary artery stenosis group were lower than those in the matched group,while,PSD and GWW were higher than those in matched group(all P<0.05).GWI,GWE,GCW and GWW all had the ability to predict coronary artery stenosis in the early stage,among which GWI had the best sensitivity,the largest positive likelihood ratio and the smallest negative likelihood ratio(at least one coronary artery stenosis rate≥70%).Conclusions LVMW parameters had changed in patients with coronary heart disease without myocardial infarction.GWI could be used as a non-invasive index to predict the degree of coronary artery stenosis,thereby providing a new reference direction for echocardiography screening for non-myocardial infarction coronary heart disease.