斑点追踪二尖瓣环位移和心肌综合指数评价COPD患者左心室收缩功能及临床应用价值

Evaluation of Left Ventricular Systolic Function in Patients with COPD by Speckle Tracking Tissue Motion Mitral Annulus Displacement and Myocardial Comprehensive Index

目的:应用斑点追踪技术(STI)检测组织运动二尖瓣环位移(TMAD)和心肌综合指数(MCI)评价慢性阻塞性肺疾病(COPD)患者左心室收缩功能的早期变化,探讨二者的相关性及诊断效能。方法:选取42例COPD患者和30例健康人群(对照组),当COPD患者肺动脉收缩压(PASP)≥40mm Hg考虑为肺动脉高压(PH)组,余患者为不伴PH组。采用3D-STI获得左室三维参数,并计算心肌综合指数(MCI=GLS×LVtw),应用2D-STI测量TMAD各参数,比较组间差异;绘制各参数的ROC曲线,分析其相关性。结果:与对照组比较:COPD组及亚组的左室舒张末容积(LVEDV)、左室收缩末容积(LVESV)及LVEF无明显差异(P>0.05);COPD组、COPD伴PH组的左室整体纵向应变(GLS)、扭转角度(LVtw)绝对值减低(P<0.05,P_(1)<0.05);COPD各亚组的TMAD参数减低(P,P_(1),P_(2)<0.01)。ROC曲线分析提示TMAD1-mid的AUC最大(0.930),且特异性最高(90.5%),LVtw和TMAD-sep的敏感性最高(100%)。相关性分析显示,TMAD1-mid、TMAD1-mid%与MCI、GLS绝对值均有良好的相关性(r>0.6,且P<0.001),且随着PASP的增高呈下降趋势。结论:TMAD、GLS及MCI均有助于发现COPD患者左心室收缩功能的早期变化,TMAD、GLS绝对值与PASP呈负相关,其中TMAD操作更便捷、省时。

Objective:To evaluate early changes of left ventricular(LV)systolic function in patients with chronic obstructive pulmonary disease(COPD)by measuring tissue movement mitral annulus displacement(TMAD)and myocardial comprehensive index(MCI)using speckle tracking imaging(STI),and to explore the correlation and diagnostic efficacy of the two methods.Methods:A total of 42 COPD patients and 30 healthy individuals(control group)were selected.The COPD patients were categorized into subgroups based on their pulmonary artery systolic pressure(PASP):PASP≥40mmHg constituted the COPD with Pulmonary Hypertension(PH)group,while PASP<40mmHg constituted the COPD without PH group.All subjects were tested using three-dimensional STI(3D-STI)to obtain the 3D parameters,and the MCI(MCI=GLS×LVtw)was calculated.The parameters of TMAD were measured by 2D-STI.The differences of all parameters between groups were compared.Receiver operating curves(ROC)were drawn and correlations between parameters were analyzed.Results:Compared with the control group,there were no statistically significant differences in LV end-diastolic volume(LVEDV),end-systolic volume(LVESV),ejection fraction(LVEF)in COPD group and subgroups(>0.05,P_(1)>0.05,P_(2)>0.05).The absolute value of LV global longitudinal strain(GLS),torsion Angle(LVtw)and MCI in the COPD group,COPD with PH group decreased(<0.05,1<0.01).The parameters of TMAD in the COPD group and subgroups were significantly lower(P<0.001,P_(1)<0.001,P_(2)<0.01).Among them,the AUC(0.93)and specificity(90.5%)of the TMAD1-mid were the highest,the sensitivity(100%)of TMAD-sep and LVtw was the highest.Correlation analysis showed that TMAD1-mid and TMAD1-mid%had positive correlation with the absolute value of MCI and GLS(>0.6,<0.001)and decreased as the PASP increased.Both TMAD and MCI had great repeatability,and TMAD was less time consuming.Conclusion:Both TMAD,GLS and MCI are helpful to detect early changes of left ventricular systolic function in COPD patients and TMAD,GLS are negatively correlated with PASP.TMAD is more convenient and time-saving.