压力-应变环评估轻链型淀粉样变性患者左心室收缩功能  

Assessment of left ventricular systolic function using pressure-strain loop in patients with light-chain amyloidosis

作　　者：刘春丽 李一丹[2] 边晓琳 翟渊鹏 周艳珂 张倩 王志伟 刘瑞 李潜 Liu Chunli;Li Yidan;Bian Xiaolin;Zhai Yuanpeng;Zhou Yanke;Zhang Qian;Wang Zhiwei;Liu Rui;Li Qian(Department of Ultrasound,Affiliated Tumor Hospital of Zhengzhou University,Zhengzhou 450008,China;Department of Echocardiography,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]郑州大学附属肿瘤医院超声科,450008 [2]首都医科大学附属北京朝阳医院心脏超声科,100020

出　　处：《中华超声影像学杂志》2021年第7期598-603,共6页Chinese Journal of Ultrasonography

基　　金：河南省科技攻关计划项目(182102310152);河南省医学科技攻关计划联合共建项目(2018020483)。

摘　　要：目的探讨左室压力-应变环(pressure-strain loop,PSL)定量评估轻链型淀粉样变性(light-chain amyloidosis,AL)患者左室收缩功能改变。方法选取2018年1月至2020年12月在郑州大学附属肿瘤医院临床确诊的AL患者46例,根据舒张末期室间隔与左室后壁厚度是否>12 mm分为2组:①室间隔与左室后壁厚度>12 mm,定义为AL伴心脏受累(cardiac amyloidosis,CA)组,21例;②室间隔与左室后壁厚度≤12 mm,定义为AL未累及心脏(non cardiac amyloidosis,NCA)组,25例。同期选取25例健康志愿者作为对照组。所有研究对象均行常规超声心动图检查。应用二维斑点追踪技术分别于左室心尖两腔、三腔、四腔心切面采集连续3个心动周期的二维动态图像,并导入Echo PAC 203图像工作站描记分析,输入血压,得出左心室心肌整体纵向应变(GLS)和纵向应变达峰时间离散度(PSD)、整体心肌做功指数(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、PSD及心肌做功各参数(GWI、GCW、GWW、GWE)的差异,并进行Pearson线性相关分析。结果①与对照组及NCA组比较,CA组IVST、LVPWT、LVMI、LAD及E/e′增大,LVEF减低(均P<0.05)。②与对照组比较,NCA组GLS、GWI及GCW减低(均P<0.05),两组间GWE、PSD及GWW差异无统计学意义(均P>0.05);与对照组、NCA组比较,CA组GLS、GWI、GCW及GWE明显减低,PSD、GWW明显增加(均P<0.05)。③相关性分析显示,GLS与GWI、GCW及GWE呈正相关(r=0.654、0.695、0.788,均P<0.001),与GWW、PSD呈负相关(r=-0.710、-0.625,均P<0.001)。PSD与GWI、GCW及GWE呈负相关(r=-0.754、-0.653、-0.702,P<0.001),与GWW呈正相关(r=0.676,均P<0.001)。结论PSL可定量评价AL患者左室收缩功能,心肌做功参数有助于AL患者病程中心脏受累程度的评估。Objective To discuss the quantitative evaluation of left ventricular systolic function in patients with light-chain amyloidosis(AL)by pressure-strain loop(PSL).Methods Forty-six patients with clinically diagnosed as AL in the Affiliated Tumor Hospital of Zhengzhou University from January 2018 to December 2020 were selected as case group,and they were divided into 2 groups according to whether the thickness of interventricular septum and posterior wall at end-diastole was>12 mm;①cardiac amyloidosis(CA)group(21 cases,the thickness>12mm);②non cardiac amyloidosis(NCA)group(25 cases,the thickness≤12 mm).Twenty five healthy volunteers were selected as control group at the same time.Routine echocardiography was performed in all subjects.Two-dimensional dynamic images of the left ventricular apical two-chamber,three-chamber,and four-chamber views were collected for three consecutive cardiac cycles using two-dimensional speckle-tracking.A tracing analysis was conducted and blood pressure was entered on the off-line Echo PAC 203 software,and the left ventricular global longitudinal strain(GLS),peak strain time dispersion(PSD),global myocardial work index(GWI),global constructive work(GCW),global wasted work(GWW)and global work efficiency(GWE)were obtained.The differences of GLS,PSD and myocardial work(GWI,GCW,GWW,GWE)parameters were compared between groups,and Pearson correlation was used to analyze the correlations.Results①Routine echocardiography:Compared with the control group and NCA group,inter-ventricular septum thickness(IVST),left ventricle posterior wall thickness(LVPWT),left ventricular mass index(LVMI),left atrial diameter(LAD),and E/e′in CA group were increased,while left ventricular ejection fraction(LVEF)was decreased;②Compared with the control group,GLS,GWI,and GCW in NCA group were decreased,while there were no statistically differences in GWE,PSD,and GWW between the two groups(all P>0.05);Compared with the control group and NCA group,GLS,GWI,GCW,and GWE were obviously decreased,while PSD and GW

关 键 词：超声心动描记术 压力-应变环 轻链型淀粉样变性 心室功能 左 心肌做功 

分 类 号：R597.2[医药卫生—内科学]