左心室压力-应变环评价心脏淀粉样变性患者心肌做功  

Assessment of myocardial work in cardiac amyloidosis patients by left ventricular pressure-strain loop

作　　者：丁雪晏 李一丹[1] 魏丽群[1] 叶晓光[1] 蔡绮哲[1] 朱维维[1] 秦芸芸 李沅芝 王江涛 吕秀章[1] Ding Xueyan;Li Yidan;Wei Liqun;Ye Xiaoguang;Cai Qizhe;Zhu Weiwei;Qin Yunyun;Li Yuanzhi;Wang Jiangtao;Lyu Xiuzhang(Department of Echocardiography,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China;Department of Clinical Research,General Electrics Cardiovascular Ultrasound,Beijing 100176,China)

机构地区：[1]首都医科大学附属北京朝阳医院心脏超声科,100020 [2]通用电气医疗心血管超声临床科研部,北京100176

出　　处：《中华超声影像学杂志》2021年第7期604-608,共5页Chinese Journal of Ultrasonography

基　　金：北京市医院管理局临床技术创新项目(XMLX201827)。

摘　　要：目的应用左室压力-应变环(PSL)无创评价心脏淀粉样变性(CA)患者整体及节段心肌做功。方法纳入2018年3月至2020年12月于首都医科大学附属北京朝阳医院就诊的CA患者18例作为CA组,20例健康受试者作为对照组。通过二维斑点追踪技术分析两组左心室整体长轴应变(GLS)及机械离散度(MD)。应用左室PSL评价心肌整体做功指数(GWI)、整体有效做功(GCW)、整体无效做功(GWW)及整体做功效率(GWE),计算基底段、中间段、心尖段心肌做功指数(MWI)、有效做功(CW)、无效做功(WW)、做功效率(WE)的平均值。对上述指标进行组间比较。结果①与对照组相比,CA组GLS减低,MD增大(均P<0.05)。②与对照组相比,CA组GWI、GCW、GWW及GWE减低(均P<0.05)。③CA组较对照组左心室基底、中间、心尖水平MWI、CW及WE减低(均P<0.05),基底、中间水平WW减低(均P<0.05),且MWI、CW、WE呈"心尖保留"趋势。④GWI、GCW、GWE分别与GLS(r=0.854、0.816、0.748,均P<0.001)、LVEF(r=0.674、0.634、0.650,均P<0.01)呈正相关,与MD呈负相关(r=-0.657、-0.672、-0.710,均P<0.01);GWI、GCW与E/e′呈负相关(r=-0.493、-0.539,均P<0.05)。结论CA患者左室整体及各水平(基底、中间、心尖)心肌做功减低。MWI、CW及WE呈"心尖保留"特点。超声心动图左室PSL定量评价心肌做功可为CA患者提供更多有价值的信息。Objective To evaluate the global and segmental myocardial work in patients with cardiac amyloidosis(CA)by left ventricular pressure-strain loop(PSL)noninvasively.Methods Eighteen patients with CA in Beijing Chao-Yang Hospital from March 2018 to December 2020 were included as CA group,20 healthy subjects were selected as control group.The global longitudinal strain(GLS)and mechanical dispersion(MD)of left ventricle were analyzed by two-dimensional speckle tracking imaging.The left ventricular PSL was used to assess global work index(GWI),global constructive work(GCW),global waste work(GWW),and global work efficiency(GWE).The mean value of left ventricular basal,mid and apical myocardial work index(MWI),constructive work(CW),waste work(WW)and work efficiency(WE)were calculated and compared between the two groups.Results①Compared with the control group,GLS was decreased and MD was increased in CA group(all P<0.05).②GWI,GCW,GWW and GWE were decreased in CA group compared with the control group(all P<0.05).③In CA group,the MWI,CW and WE of the basal,mid and apical segments were lower than those of control group(all P<0.05),WW of the basal and mid segments were lower than those of apical segment(all P<0.05).The impairment of MWI,WW and WE in basal and mid segment were more significant than those of apical segment(all P<0.05).④GWI,GCW and GWE were positively correlated with GLS(r=0.854,0.816,0.748;all P<0.001)and LVEF(r=0.674,0.634,0.650;all P<0.01),and negatively correlated with MD(r=-0.657,-0.672,-0.710,all P<0.01).GWI and GCW were negatively correlated with E/e′(r=-0.493,-0.539;all P<0.05).Conclusions The global,basal,mid and apical left ventricular myocardial work indices are decreased in CA patients.MWI,CW and WE show an apical sparing pattern.Quantitative assessment of myocardial work by PSL may provide more valuable information for CA patients.

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

分 类 号：R541[医药卫生—心血管疾病]