摘要
目的探讨左室压力-应变环(PSL)评估慢性心力衰竭(CHF)患者左心室心肌做功的应用价值。方法选取2018年12月至2019年5月在华中阜外医院就诊的CHF患者70例和同期健康志愿者33例(对照组)进行研究,70例CHF患者根据2014版心力衰竭指南左心室射血分数(LVEF)不同分为2组:LVEF保留组(HFpEF组,LVEF≥50%)35例和LVEF减低组(HFrEF组,LVEF<50%)35例。应用二维斑点追踪技术分别于左心室心尖两腔、三腔、四腔心切面采集二维动态图像并导入EchoPAC工作站描记分析,输入血压,得出左心室心肌整体纵向应变(GLS)和心肌整体做功指数(GWI)、整体有用功(GCW)、整体无用功(GWW)和整体做功效率(GWE),比较各组间GLS、心肌做功(GWI、GCW、GWW、GWE)的差异。心肌做功参数与LVEF的相关性采用Pearson线性相关分析。结果与对照组和HFpEF组比较,HFrEF组LAD、LVDd、LVEDV、LVESV均增大,LVEF减低(均P<0.05);与对照组比较,HFpEF组LAD增大(P<0.05)。与对照组比较,HFpEF组、HFrEF组GLS、GWI、GCW明显减低(均P<0.05),HFrEF组GWW增高、GWE减低(均P<0.05);与HFpEF组比较,HFrEF组GLS、GWI、GCW、GWE减低,GWW增高,差异有统计学意义(均P<0.05)。CHF患者的GWW与LVEF呈负相关(r=-0.521,P<0.001),GWI、GCW、GWE与LVEF呈正相关(r=0.846,0.807,0.788;均P<0.001)。结论PSL能有效评估CHF患者左心室心肌做功,与LVEF具有一定相关性,进而反映左心室收缩功能,为CHF的临床诊断、预后评估提供新的参考指标。
Objective To explore the application value of pressure-strain loop(PSL)in evaluating left ventricular myocardial work(MW)in patients with chronic heart failure(CHF).Methods Seventy patients with CHF were selected as case group(CHF group)and were divided into 2 groups according to the left ventricular ejection fraction(LVEF)in ultrasonic cardiogram:LVEF preserve group(HFpEF group,LVEF≥50%,n=35)and LVEF reduced group(HFrEF group,LVEF<50%,n=35).Thirty-three healthy volunteers were selected as control group at the same period.Two-dimensional dynamic images in apical two chamber,three chamber and four chamber views were collected by two-dimensional speckle-tracking.Using the off-line EchoPAC software,a tracing analysis was conducted and the blood pressure was entered to obtain left ventricular global longitudinal strain(GLS),global MW index(GWI),global constructive work(GCW),global wasted work(GWW)and MW efficiency(GWE).The differences of GLS and MW parameters(GWI,GCW,GWW,GWE)were compared between each groups,and Pearson correlation was used to analyze the correlation between MW parameters and LVEF.Results Compared with the control group and HFpEF group,the left atrial dimension(LAD),left ventricular end-diastolic dimension(LVDd),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV)in HFrEF group increased,while LVEF decreased significantly(P<0.05).Compared with the control group,LAD in HFpEF group increased,the vaules of GLS,GWI,GCW were obviously lower in HFpEF group and HFrEF group(all P<0.05),GWW was higher and GWE was lower in HFrEF group(all P<0.05).GLS,GWI,GCW,GWE decreased and GWW increased in HFrEF group than those in HFpEF group,and all the differences were statistically significant(all P<0.05).In CHF group,GWW was negatively correlated with LVEF(r=-0.521,P<0.001)while positive correlations between GWI,GCW,GWE and LVEF were discovered(r=0.846,0.807,0.788;all P<0.001).Conclusions PSL can effectively evaluate the left ventricular MW in CHF patients.It has a certain correlation with LVEF and can reflect left ventricular systolic function.It provides a new reference index for the clinical diagnosis and evaluation of prognosis in CHF patients.
作者
李亚南
崔存英
刘园园
胡彦斌
王莹
张娟
刘瑞杰
刘琳
Li Yanan;Cui Cunying;Liu Yuanyuan;Hu Yanbin;Wang Ying;Zhang Juan;Liu Ruijie;Liu Lin(Department of Ultrasound,Henan Province People′s Hospital,Fuwai Central China Cardiovascular Hospital,People′s Hospital of Zhengzhou University,Zhengzhou 450003,China)
出处
《中华超声影像学杂志》
CSCD
北大核心
2020年第1期13-18,共6页
Chinese Journal of Ultrasonography
基金
国家自然科学基金(81401419)
河南省科技厅科技攻关项目(17210231003)
河南省医学科技攻关计划项目(2018020452)。
