无创左室压力-应变环技术评估不同心率甲亢患者左室心肌功能

Evaluation of left ventricular myocardial function in hyperthyroidism patients with different heart rates by non-invasive left ventricular pressure-strain loop technology

目的:研究无创左室压力-应变环(LV-PSL)技术评估不同心率甲亢患者心肌功能的临床应用价值。方法:根据纳入及排除标准在湖北医药学院附属襄阳市第一人民医院收集71名初次确诊且未经治疗的甲亢患者。依据是否心动过速分为A组[心率(HR)<100次/min,n=38]及B组(HR>100次/min,n=33),对照组纳入健康志愿者(n=50)。比较各组参数的差异;探讨HR与心肌做功参数[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)]的相关性。绘制受试者工作特征(ROC)曲线,分析左室整体纵向应变(GLS)与心肌做功参数评估甲亢患者左室心肌功能的效能。结果:相较于对照组,A组和B组的收缩压(SBP)、HR、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、病程、主动脉舒张末期内径(AOEDD)、GWW均增高,而促甲状腺素(TSH)、GLS、GWI、GCW、GWE均降低,差异具有统计学意义(P<0.05)。相较于A组,B组的SBP、HR、FT3、FT4、病程、GWW增高,而GWE降低,差异具有统计学意义(P<0.05)。相关性分析显示,HR与GLS、GWI、GCW、GWE呈负相关,与GWW呈正相关。GLS、GWI、GCW、GWW及GWE评估甲亢患者左室功能的曲线下面积分别为:0.754、0.795、0.728、0.836及0.850。其中,GWW与GWE评估效能较高。结论:无创LV-PSL技术可早期定量评估不同心率甲亢患者左心室功能,可为临床早期预警、早期干预提供参考价值。

Objective:To explore the clinical application value of non-invasive left ventricular pressurestrain loop(LV-PSL)technology in evaluating the myocardial function of hyperthyroidism patients with different heart rates(HR).Methods:According to the inclusion and exclusion criteria,71 patients with newly diagnosed and untreated hyperthyroidism were collected.Based on the presence or absence of tachycardia,the patients were divided into group A(HR<100 beats/min,n=38)and group B(HR>100 beats/min,n=33),and healthy volunteers(n=50)were included as the control group.The differences in parameters among the groups were compared;the correlation between HR and global work index(GWI),global constructive work(GCW),and global wasted work(GWW)with global work efficiency(GWE).The receiver operating characteristic(ROC)curve was drawn to analyze the efficacy of global longitudinal strain(GLS)and myocardial work parameters for evaluating left ventricular myocardial function in patients with hyperthyroidism.Results:Compared with the control group,both group A and group B had increased systolic blood pressure(SBP),HR,free triiodothyronine(FT3),free thyroxine(FT4),disease course,aortic end-diastolic diameter(AOEDD),and GWW,but decreased thyroid stimulating hormone(TSH),GLS,GWI,GCW,and GWE(P<0.05).Compared with group A,group B had increased SBP,HR,FT3,FT4,disease course,and GWW,but decreased GWE(P<0.05).Correlation analysis showed that HR was negatively correlated with GLS,GWI,GCW,and GWE,and positively correlated with GWW.The area under the curve of GLS,GWI,GCW,GW,GW,and GWE for evaluating left ventricular function in patients with hyperthyroidism was 0.754,0.795,0.728,0.836,and 0.850.Among them,GWW and GWE had higher evaluating efficacy than other parameters.Conclusion:Non-invasive LV-PSL technology can be used to early and quantitatively evaluate the left ventricular myocardial function in hyperthyroidism patients with different heart rates,which can provide reference value for early warning and early intervention in clinical practice.