陈碧华, 黄定伟, 许厚本. 无创左心室压力-应变环定量评价冠心病患者冠状动脉狭窄[J]. 心脏杂志, 2023, 35(2): 191-195. DOI: 10.12125/j.chj.202203073
    引用本文: 陈碧华, 黄定伟, 许厚本. 无创左心室压力-应变环定量评价冠心病患者冠状动脉狭窄[J]. 心脏杂志, 2023, 35(2): 191-195. DOI: 10.12125/j.chj.202203073
    Bi-hua CHEN, Ding-wei HUANG, Hou-ben XU. Quantitative evaluation of coronary artery stenosis in patients with coronary atherosclerotic heart disease by left ventricular pressure-strain loops[J]. Chinese Heart Journal, 2023, 35(2): 191-195. DOI: 10.12125/j.chj.202203073
    Citation: Bi-hua CHEN, Ding-wei HUANG, Hou-ben XU. Quantitative evaluation of coronary artery stenosis in patients with coronary atherosclerotic heart disease by left ventricular pressure-strain loops[J]. Chinese Heart Journal, 2023, 35(2): 191-195. DOI: 10.12125/j.chj.202203073

    无创左心室压力-应变环定量评价冠心病患者冠状动脉狭窄

    Quantitative evaluation of coronary artery stenosis in patients with coronary atherosclerotic heart disease by left ventricular pressure-strain loops

    • 摘要:
        目的  探讨无创左心室压力-应变环(LVPSL)对冠状动脉不同程度狭窄的冠心病(CAD)患者心肌做功的评价。
        方法  回顾性选择2019年12月~2021年10月就诊于湖南中医药高等专科学校附属第一医院心血管内科临床诊断为疑似CAD且行冠状动脉造影检查的患者130例,所有患者均行常规超声心动图、二维斑点追踪(2D-STI)和LVPSL检查。根据冠状动脉造影结果将其分为冠状动脉无狭窄组(n=33),冠状动脉有狭窄组(n=97)。依据冠状动脉Gensini评分将冠状动脉有狭窄组分为三个亚组,轻度狭窄组(Gensini评分<25,n=37),中度狭窄组Gensini评分(25~50),n=32,重度狭窄组(Gensini评分>50,n=28)。采集常规超声心动参数的同时,取左心室心尖四腔心、三腔心、两腔心切面三个心动周期在二维斑点追踪(2D-STI)模式下获得左心室整体纵向应变(GLS)。输入实时血压,进入LVPSL模式,可获得左心室整体做功指数(GWI)、整体有效做功(GCW)、整体无效做功(GWW)和整体做功效率(GWE)参数。比较不同程度冠状动脉狭窄对心肌做功的影响。
        结果  与冠状动脉无狭窄组相比,冠状动脉轻度狭窄组GLS的减低、GWI减低、GCW减低、GWE减低和GWW增加(均P<0.01);冠状动脉中度狭组GLS减低、GWI减低、GCW减低、GWE减低和GWW增加(均P<0.01);冠状动脉重度狭窄组GLS减低、GWI减低、GCW减低、GWE减低和GWW增加(均P<0.01)。与冠状动脉轻度狭窄相比,冠状动脉中度狭窄组GLS减低、GWI减低、GCW减低、GWE减低和GWW增加(均P<0.01);冠状动脉重度狭组GLS减低、GWI减低、GCW减低、GWE减低和GWW增加(均P<0.01);与冠状动脉中度狭窄相比,冠状动脉重度狭窄组GLS减低、GWI减低、GCW减低、GWE减低和GWW增加(均P<0.01)。冠状动脉狭窄组的Gensini评分与GLS的绝对值、GWI、GCW、GWE呈负相关(r=−0.554, −0.661, −0.619, −0.829),与GWW呈正相关(r=0.718),其中与GWE的相关性最高。
        结论  LVPSL技术测得的GWI、GCW、GWE和GWW可定量分析不同程度冠状动脉狭窄的CAD患者心肌做功情况,心肌做功参数GWE与Gensini评分的相关性最高。

       

      Abstract:
        AIM   To explore the value of non-invasive left ventricular pressure-strain loop (LVPSL) in evaluating myocardial work in patients with coronary atherosclerotic heart disease (CAD) of different degrees of coronary stenosis.
        METHODS  One hundred and thirty patients who were clinically diagnosed with suspected CAD and underwent coronary angiography from December 2019 to October 2021 in the Department of Cardiovascular Medicine of the First Affiliated Hospital of Hunan Traditional Chinese Medicine College were selected prospectively for routine echocardiography and LVPSL examination. According to the results of coronary angiography, the patients were divided into group without coronary artery stenosis (n=33) and group with coronary artery stenosis (n=97) according to the coronary artery Gensini score. The group with coronary artery stenosis was further divided into three subgroups: mild stenosis group (Gensini score <25, n=37), moderate stenosis group Gensini score (25~50), n=32 and severe stenosis group (Gensini score >50, n=28). Simultaneous cardiac conductance was connected to collect conventional echocardiography parameters and three cardiac cycles were taken from the left ventricular apical four-chamber heart, three-chamber heart and two-chamber heart section to obtain the overall longitudinal strain (GLS) of the left ventricle in the mode of two-dimensional speckle tracking imaging. Left ventricular global work index (GWI), global effective work (GCW), global ineffective work (GWW) and global work efficiency (GWE) were evaluated by LVPSL, and the effects of different degrees of coronary artery stenosis on the left ventricular systolic function and myocardial work were compared.
        RESULTS  Compared with the group without coronary artery stenosis, the GLS decreased, GWI decreased, GCW decreased, GWE decreased and GWW increased (all P<0.01) in the group with mild coronary artery stenosis; In the group of moderate coronary artery stenosis, GLS decreased, GWI decreased, GCW decreased, GWE decreased and GWW increased (all P<0.01); In severe coronary artery stenosis group, GLS, GWI, GCW, GWE decreased and GWW increased (all P<0.01). Compared with mild coronary artery stenosis, GLS,GWI, GCW, GWE decreased and GWW increased in moderate coronary artery stenosis group (all P<0.01); In severe coronary artery stenosis group, GLS decreased, GWI decreased, GCW decreased, GWE decreased and GWW increased (all P<0.01); Compared with moderate coronary artery stenosis, GLS, GWI, GCW, GWE decreased and GWW increased in severe coronary artery stenosis group (all P<0.01). The Gensini score of coronary artery stenosis group was negatively correlated with the absolute value of GLS, GWI, GCW, GWE (r=−0.554, −0.661, −0.619, −0.829), and positively correlated with GWW (r=0.718), of which the correlation with GWE was the highest.
        CONCLUSION  GWI, GCW, GWE and GWW measured by LVPSL technique can quantitatively analyze the myocardial work of CAD patients with different degrees of coronary artery stenosis and the correlation between GWE and Gensini score is superior to that of GLS.

       

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