无创心肌做功评价完全性左束支传导阻滞患者左室功能的临床价值

Clinical value of non-invasive myocardial work in evaluating left ventricular function in patients with complete left bundle branch block

目的 探讨无创心肌做功评价完全性左束支传导阻滞(CLBBB)患者左室功能的临床价值。方法 选取我院CLBBB患者56例,包括左室射血分数(LVEF)正常者30例(射血分数正常组)及LVEF减低者26例(射血分数减低组),另选同期年龄、性别与之匹配的40例健康志愿者作为对照组,应用常规超声心动图获取左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)及LVEF;二维斑点追踪技术获取整体纵向峰值应变(GLS)、峰值应变离散度(PSD),结合纵向应变参数和血压获取心肌做功参数,包括整体做功效率(GWE)、整体做功指数(GWI)、整体有用功(GCW)、整体无用功(GWW)、18节段心肌做功指数(WI),比较各组上述参数的差异;分析心肌做功参数与LVEF、GLS、PSD的相关性。结果 与对照组比较,射血分数正常组和射血分数减低组GLS减低,PSD增加,射血分数减低组LVEDV、LVESV均增加,LVEF减低,差异均有统计学意义(均P<0.05);与射血分数正常组比较,射血分数减低组LVEDV、LVESV、PSD均增加,LVEF、GLS均减低,差异均有统计学意义(均P<0.05)。与对照组比较,射血分数正常组和射血分数减低组GWI、GWE均减低,GWW增加,射血分数减低组GCW减低,差异均有统计学意义(均P<0.05);与射血分数正常组比较,射血分数减低组GWI、GWE、GCW均减低,GWW增加,差异均有统计学意义(均P<0.05)。与对照组比较,射血分数正常组和射血分数减低组前间隔和后间隔基底段、中间段、心尖段WI均减低,射血分数正常组后壁、侧壁、前壁基底段及侧壁中间段WI均增加,下壁中间段、心尖段及后壁心尖段WI均减低,射血分数减低组前壁、下壁、后壁基底段、中间段、心尖段及侧壁中间段、心尖段WI均减低,差异均有统计学意义(均P<0.05);与射血分数正常组比较,射血分数减低组所有节段WI均减低,差异均有统计学意义(均P<0.05)。相关性分析显示,GWI、GWE、GCW与LVEF、GLS均呈正相关,与PSD均呈负相关(均P<0.001);GWW与LVEF、GLS均呈负相关,与PSD呈正相关(均P<0.001);侧壁、前间隔、后间隔基底段WI与LVEF、GLS均呈正相关,与PSD均呈负相关(均P<0.001)。结论 无创心肌做功在评价CLBBB患者左室整体及节段收缩功能方面有一定的临床应用价值。

Objective To explore the clinical value of non-invasive myocardial work in evaluating left ventricular function in patients with complete left bundle branch block(CLBBB).Methods A total of 56 patients with CLBBB in our hospital were selected,including 30 cases with normal left ventricular ejection fraction(LVEF)in the normal ejection fraction group and 26 cases with reduced LVEF in the reduced ejection fraction group.Additionally,40 age-and sex-matched healthy volunteers were selected as the control group.Conventional echocardiography was used to obtain left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV)and LVEF.Two-dimensional speckle tracking imaging was used to obtain global longitudinal strain(GLS)and peak strain dispersion(PSD).Myocardial work parameters,including global work efficiency(GWE),global work index(GWI),global constructive work(GCW),global wasted work(GWW)and the 18-segment myocardial work index(WI)were calculated based on longitudinal strain parameters and blood pressure.The differences of above parameters in each group were compared.The correlations between myocardial work parameters and LVEF,GLS and PSD were analyzed.Results Compared with the control group,GLS decreased and PSD increased in the normal and reduced ejection fraction groups,while LVEDV and LVESV increased,and LVEF decreased in the reduced ejection fraction group,with statistically significant differences(all P<0.05).Compared with the normal ejection fraction group,LVEDV,LVESV and PSD increased,LVEF and GLS decreased in the reduced ejection fraction group,with statistically significant differences(all P<0.05).Compared with the control group,GWI,GWE decreased and GWW increased in the normal and reduced ejection fraction groups,GCW decreased in the reduced ejection fraction group,with statistically significant differences(all P<0.05).Compared with the normal ejection fraction group,GWI,GWE and GCW decreased,and GWW increased in the reduced ejection fraction group,with statistically significant differences(all P<0.05).Compared with the control group,the anterior septum and posterior septum basal,mid and apical segment WI decreased in the normal and reduced ejection fraction groups,WI in the posterior wall,lateral wall,anterior wall basal segments and lateral wall mid-segment increased,and WI in the inferior wall mid-segment,apical segment and posterior wall apical segment decreased in the normal ejection fraction group,WI in all segments decreased in the reduced ejection fraction group,with statistically significant differences(all P<0.05).Correlation analysis showed that GWI,GWE and GCW were positively correlated with LVEF and GLS,while negatively correlated with PSD(all P<0.001).GWW was negatively correlated with LVEF and GLS,while positively correlated with PSD(all P<0.001).WI in the lateral wall,anterior septum and posterior septum basal segments were positively correlated with LVEF and GLS,while negatively correlated with PSD(all P<0.001).Conclusion Non-invasive myocardial work has a certain clinical application value in assessing global and segmental left ventricular systolic function in patients with CLBBB.