左室压力-应变环定量评价肺动脉高压患者心肌做功的临床研究  

Quantitative Evaluation of Left Ventricular Myocardial Work in Patients with Pulmonary Hypertension by Pressure-strain Loop

作　　者：张鑫媛 李一丹[1] 秦芸芸 丁雪晏 郭迪晨 王江涛 吕秀章[1] Zhang Xinyuan;Li Yidan;Qin Yunyun;Ding Xueyan;Guo Dichen;Wang Jiangtao;Lü Xiuzhang(Department of Echocardiography,Heart Center,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,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,北京市100020

出　　处：《中国超声医学杂志》2021年第12期1369-1373,共5页Chinese Journal of Ultrasound in Medicine

基　　金：国家自然科学基金项目(No.81871356);北京市属医院科研培育计划(No.PX2019013)。

摘　　要：目的探讨无创性左室压力-应变环定量评价的心肌做功参数在肺动脉高压(PH)患者临床评估中的应用价值。方法选取临床确诊PH患者39例及同期健康志愿者20例。所有受试者均进行经胸超声心动图检查.并脱机分析测量左室整体长轴应变(GLS)、整体做功指数(GWI)、整体有用功(GCW)、整体无用功(GWW)及整体做功效率(GWE)。比较PH组与对照组间心肌做功的差异,分析心肌做功参数与左室射血分数(LVEF)、GLS、三尖瓣环收缩期位移(TAPSE)、肺动脉收缩压(PASP)及肱动脉收缩压的相关性。结果①组间分析:PH组GLS绝对值、GWI、GCW、GWE均较对照组明显减低,GWW明显升高(P<0.05);②相关性分析:GWI、GCW、GWW、GWE与GLS均具有显著相关性(P<0.01),GWW、GWE与PASP具有显著相关性(P<0.01),仅GWE与TAPSE呈正相关(P<0.01)。结论无创左室压力-应变环定量评估的左室心肌做功可敏感识别PH患者左室收缩功能障碍,为临床评估提供更多参考信息。Objective To investigate the application value of myocardial work, which quantified by noninvasive left ventricular pressure-strain loop, in the clinical evaluation of patients with pulmonary hypertension(PH). Methods Thirty-nine patients with PH and twenty healthy controls were measured by echocardiography. The images were analyzed offline to calculate the left ventricular global longitudinal strain(GLS), global myocardial work index(GWI), global constructive work(GCW), global wasted work(GWW) and global myocardial work efficiency(GWE). The difference of myocardial work between PH group and control group were compared. The correlation between myocardial work parameters and left ventricular ejection fraction(LVEF), GLS, tricuspid annular plane systolic excursion(TAPSE), pulmonary artery systolic pressure(PASP) and brachial artery systolic pressure was analyzed. Results Intergroup analysis: Compared with the control group, absolute value of GLS, GWI, GCW, GWE of the left ventricle in PH group were decreased, while GWW was increased significantly(P<0.05). Correlation analysis: GWI, GCW, GWW, GWE were significantly related to GLS(P<0.01). GWW, GWE were significantly related to pulmonary artery systolic pressure(PASP)(P<0.01), while only GWE was positively related with tricuspid annular plane systolic excursion(TAPSE)(P<0.01). Conclusions Noninvasive quantitative assessment of left ventricular pressure-strain loop can sensitively identify left ventricular systolic dysfunction in patients with PH, and provide more reference information for clinical evaluation.

关 键 词：超声心动描记术 肺动脉高压 压力-应变环 心肌做功 心室功能 左 

分 类 号：R544.1[医药卫生—心血管疾病]