射血分数保留型阵发性房颤患者左心室心肌做功的临床研究

Clinical study of left ventricular myocardial work in patients with paroxysmal atrial fibrillation with preserved left ventricular ejection fraction

目的应用压力-应变环技术(pressure-strain loops,PSL)评价射血分数保留型阵发性房颤患者左心室做功情况。方法回顾2022年10月至2023年11月郑州大学第一附属医院心内科收治的30例LVEF保留型阵发性房颤患者作为房颤组,另纳入30例健康者作为对照组,所有研究对象均行常规超声心动图检查,采集标准心尖两腔心、三腔心、四腔心切面动态图像,应用压力-应变环分析左心室心肌做功,比较两组间整体纵向应变(global longitudinal strain,GLS)、整体做功指数(global work index,GWI)、整体有用功(global constructive work,GCW)、整体做功效率(global work efficiency,GWE)、整体无用功(global wasted work,GWW)的差异。心肌做功参数与GLS的相关性采用Pearson或者Spearman秩相关分析。结果与对照组相比,房颤组GLS、GWI、GCW、GWE减低,差异均有统计学意义(P<0.05),GWW增高,差异有统计学意义(P<0.05);GWI、GCW、GWE与GLS呈正相关(r=0.723、0.640、0.695),GWW与GLS呈负相关(r=-0.733)。结论压力-应变环可以敏感地检测房颤患者心肌做功的改变,早期发现射血分数保留型房颤患者左心室心肌受损,对左心室做功异常作出诊断,为临床评价房颤患者左心室收缩功能障碍提供重要信息。

Objective To evaluate left ventricular work in patients with paroxysmal atrial fibrillation with preserved left ventricular ejection fraction by use of pressure-strain loops(PSL).Methods Totally 30 paroxysmal AF patients with preserved LVEF retrospectively analyzed in the Department of Cardiology of the First Affiliated Hospital of Zhengzhou University from October 2022 to November 2023 were selected as the AF group,and 30 healthy subjects were selected control as group.All subjects underwent routine echocardiography,the dynamic images were collected in standard apical two chamber heart,three chamber heart and four chamber heart sections.The left ventricular work was analyzed by pressure-strain loop,and the differences of global longitudinal strain(GLS),global work index(GWI),global constructive work(GCW),global work efficiency(GWE),and global wasted work(GWW)between the two groups were compared.The correlation between myocardial work parameters and GLS was analyzed by Pearson or Spearman's Correlation statistical method.Results Compared with the control group,GLS,GWI,GCW and GWE in the AF group decreased,with statistically significant differences(P<0.05),while GWW increased,with statistically significant differences(P<0.05);GWI,GCW and GWE were positively correlated with GLS(r=0.723、0.640、0.695),and GWW was negatively correlated with GLS(r=-0.733).Conclusion PSL showed high sensitivity on detecting left ventricular myocardial work changes,therefore can early detect left ventricular myocardial damage in patients with ejection fraction preserved atrial fibrillation,and diagnose abnormal left ventricular work,providing important information for clinical evaluation of left ventricular systolic dysfunction in patients with atrial fibrillation.