摘要
目的探讨左心室压力-应变环(PSL)及Tei指数联合在评价左心室射血分数(LVEF)保留的慢性中重度主动脉瓣反流(AR)患者左心室功能及心肌做功变化中的应用价值。方法这是一项前瞻性研究。选取自2022年1月至2023年2月于浙江大学医学院附属第一医院就诊的慢性中重度AR患者40例,选取健康体检者40例作为正常对照组。应用PSL获取左心室心肌做功参数,包括左心室整体心肌做功指数(GWI)、整体有效做功(GCW)、整体无效做功(GWW)、整体做功效率(GWE),并计算Tei指数,比较AR组与对照组之间各参数的差异,采用ROC曲线分析各项参数及PSL联合Tei指数对慢性中重度AR患者早期左心室心肌功能受损的诊断效能。结果与对照组相比,AR组的舒张压、左心室整体纵向应变(GLS)、GWI、GWE减低,脉压差、GWW、Tei指数升高,差异均有统计学意义(P<0.05)。ROC曲线结果显示,PSL联合Tei指数诊断AR患者早期左心室心肌功能受损的ROC曲线下面积最大,为0.922(95%CI:0.86~0.98),其敏感度为85.0%,特异度为87.6%,约登指数为0.725。结论PSL和Tei指数两种技术联合,可以更好评价LVEF保留的慢性AR患者左心室功能的改变情况,有助于为手术时机的选择提供参考。
Objective To investigate the clinical value of the combination of left ventricular pressure strain loop(PSL)and Tei index in evaluating left ventricular function and myocardial work changes in patients with chronic moderate to severe aortic regurgitation(AR)with preserved left ventricular ejection fraction(LVEF).Methods This is a prospective study in which 40 patients with chronic moderate to severe AR who visited the First Affiliated Hospital of Zhejiang University School of Medicine from January 2022 to February 2023,and 40 healthy individuals(normal controls)were included.PSL was used to obtain left ventricular myocardial work parameters,including left ventricular global myocardial work index(GWI),global myocardial constructive work(GCW),global myocardial wasted work(GWW),and global myocardial work efficiency(GWE),and Tei index was calculated.The differences in various parameters were compared between the AR group and the control group.Receiver operating characteristic(ROC)curve analysis was performed to assess the diagnostic efficacy of various parameters and PSL combined with Tei index for early left ventricular myocardial dysfunction in chronic moderate to severe AR patients.Results Compared with the control group,the diastolic blood pressure,global longitudinal strain(GLS),GWI,and GWE of the AR group decreased significantly,while the pulse pressure difference,GWW,and Tei index increased significantly(P<0.05).ROC curve analysis showed that the area under the ROC curve of PSL combined with Tei index for diagnosing early left ventricular myocardial dysfunction in AR patients was the largest(0.922;95%confidence interval:0.86-0.98),with a sensitivity of 85.0%,specificity of 87.6%,and Yoden index of 0.725.Conclusion The combination of PSL and Tei index can better evaluate the changes in left ventricular function in chronic AR patients with preserved LVEF,and provide reference for the selection of proper surgical timing.
作者
陈佳易
袁帅
胡胜男
步笑辉
牟芸
郑哲岚
Chen Jiayi;Yuan Shuai;Hu Shengnan;Bu Xiaohui;Mou Yun;Zheng Zhelan(Echocardiography Center,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Department of Ultrasound Medicine,Hangzhou Special Service Sanatorium,Air Force,Hangzhou 310002,China)
出处
《中华医学超声杂志（电子版）》
CSCD
北大核心
2023年第12期1231-1236,共6页
Chinese Journal of Medical Ultrasound(Electronic Edition)
基金
浙江省自然科学基金项目(LSD19H180002)
