超声心肌做功和核素心肌显像参数与冠心病左心室重构的关系及联合预测效能

Relationship of Ultrasonic Myocardial Work and Myocardial Perfusion Im⁃aging Parameters with Left Ventricular Remodeling in Coronary Heart Dis⁃ease and Their Combined Predictive Efficacy

目的 探讨超声心肌做功(MW)和核素心肌显像(MPI)参数与冠心病(CHD)左心室重构的关系及联合预测效能。方法 选取2020年9月-2022年9月收治的CHD 100例,根据随访6个月后是否发生左心室重构分为重构组23例与未重构组77例。比较2组临床资料,心功能指标[左心室射血分数(LVEF)、左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)],超声MW参数[整体心肌做功指数(GWI)、整体心肌有效做功(GCW)、整体心肌无用功(GWW)、心肌做功效率(GWE)],MPI参数[相位直方图带宽(PHB)、相位标准差(PSD)、R-MPI评分],分析上述参数与CHD患者左心室重构的关系及对其预测效能,以及超声MW、MPI参数对CHD左心室重构风险的影响。结果 重构组LVEF低于未重构组,LVESV、LVEDV大于未重构组,GWI、GCW、GWE低于未重构组,GWW、PHB、PSD、R-MPI评分高于未重构组(P<0.01);GWI、GCW、GWE与LVEF呈正相关,与LVESV、LVEDV呈负相关,GWW、PHB、PSD、R-MPI评分与LVEF呈负相关,与LVESV、LVEDV呈正相关(P<0.01);GWI、GCW、GWE、GWW、PHB、PSD、R-MPI评分均对左心室重构风险有重要影响(P<0.01);超声MW参数GWI、GCW、GWE、GWW与MPI参数PHB、PSD、R-MPI评分联合预测CHD患者左心室重构的曲线下面积为0.929(95%CI:0.859,0.970),敏感度为82.61%,特异度为90.91%,优于各指标单独预测。结论 超声MW和MPI参数与CHD患者左心室重构风险密切相关,均可作为预测指标,且联合预测效能较高,能为临床早期防治提供可靠的指导信息。

Objective To investigate the relationship between ultrasonic myocardial work(MW),myocardial perfu-sion imaging(MPI)parameters and left ventricular remodeling in coronary heart disease(CHD)and their combined predic-tive efficacy.Methods A total of 100 patients with CHD treated from September 2020 to September 2022 were selected and divided into remodeling group(n=23)and non-remodeling group(n=77)according to presence of left ventricular remode-ling at 6 months after follow-up.The clinical data,cardiac function indexes[left ventricular ejection fraction(LVEF),left ventricular end-systolic volume(LVESV),left ventricular end-diastolic volume(LVEDV)],ultrasonic MW parameters[global myocardial work index(GWI),global constructive work(GCW),global wasted myocardial work(GWW),global myocardial work efficiency(GWE)],and MPI parameters[phase histogram bandwidth(PHB),phase standard deviation(PSD),R-MPI score]of the two groups were compared.The relationship between the above parameters and left ventricular remodeling in CHD patients and their predictive efficacy were analyzed,as well as the effects of ultrasonic MW and MPI pa-rameters on the risk of left ventricular remodeling in CHD patients.Results LVEF was lower,while LVESV and LVEDV were higher in remodeling group than in non-modeling group;GWI,GCW and GWE in the remodeling group were lower than those in the non-remodeling group,while GWW,PHB,PSD and R-MPI scores were higher than those in the non-remodeling group(P<0.01).GWI,GCW and GWE were positively correlated with LVEF and negatively correlated with LVESV and LVEDV;GWW,PHB,PSD and R-MPI scores were negatively correlated with LVEF and positively correlated with LVESV and LVEDV(P<001).GWI,GCW,GWE,GWW,PHB,PSD and R-MPI scores had significant effects on the risk of left ventricular remodeling(P<001).The area under the receiver operating characteristic(ROC)curve(AUC)of ultrasonic MW parameters GWI,GCW,GWE,GWW combined with MPI parameters PHB,PSD,R-MPI scores in predicting left ven-tricular remodeling in CHD patients was 0.929(95%CI:0.859,0.970),the sensitivity was 82.61%,and the specificity was 90.91%,which were better than each index alone.Conclusion Ultrasonic MW and MPI parameters are closely related to the risk of left ventricular remodeling in patients with CHD,and both can be used as predictive indicators.The combined predictive efficacy is high,and can provide reliable guidance information for early prevention and treatment in clinical prac-tice.