左室压力-应变环评价心肌做功在射血分数保留型心衰中的应用价值  

Application Value of Evaluating Myocardial Work by Left Ventricular Pressure-strain Loop in Heart Failure with Preserved Ejection Fraction

作　　者：孙世杰 刘冲 田家玮[1] Sun Shijie;Liu Chong;Tian Jiawei(Department of Ultrasound,The Second Affiliated Hospital of Harbin Medical University,Harbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第二医院超声医学科,哈尔滨市150001

出　　处：《中国超声医学杂志》2022年第7期779-782,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的 应用左室压力-应变环(PSL)评价射血分数保留型心衰(HFpEF)患者的左室心肌做功,探讨心肌做功参数对不同舒张功能状态的HFpEF的诊断价值。方法 选取HFpEF的患者76例,根据超声结果将其分为舒张功能减低Ⅰ级组(A组)40例、舒张功能减低Ⅱ级组(B组)36例,另选取同期健康体检者40例作为对照组。应用PSL测量GWI、GCW、GWW及GWE等心肌做功相关参数。比较各组间常规超声心动图参数、左室整体纵向应变(GLS)及心肌做功参数间的差异。结果 (1)与对照组比较,A组患者的GWI、GWE、GCW明显减低(P<0.001);B组患者的GWW明显增高,GWI、GWE、GCW、GLS均明显减低(P<0.001);(2)与A组比较,B组患者的GWW明显增高,GWI、GWE、GCW、GLS均明显减低(P<0.001);(3)GWI、GWE、GCW、GWW及GLS对舒张功能减低Ⅱ级均具有较高的诊断价值。结论 应用PSL测得的心肌做功参数反映不同舒张功能状态下HFpEF患者左室收缩功能的早期改变优于GLS,有望为临床评估HFpEF患者左室收缩功能提供更为灵敏的心肌力学量化参考指标。Objective Evaluation of left ventricular myocardial work in patients with heart failure with preserved ejection fraction(HFpEF) by pressure-strain loop(PSL),and to explore its diagnostic value in HFpEF patients with different diastolic function states. Methods 76 HFpEF patients were selected. According to the results of ultrasound, 40 cases were divided into grade Ⅰ diastolic dysfunction group(group A) and 36 cases were grade Ⅱ diastolic dysfunction group(group B). In addition, 40 healthy volunteers were recruited as control group at the same period. Global work index(GWI), global constructive work(GCW), global wasted work(GWW) and global work efficiency(GWE) were measured by PSL. The differences of conventional echocardiographic parameters, left ventricular global longitudinal strain(GLS) and parameters of myocardial work were compared and analyzed among these groups. Results(1) Compared with the control group, GWI, GWE and GCW in group A were significantly decreased(P<0.001). GWW of group B was significantly increased, while GWI, GWE, GCW and GLS were significantly decreased(P<0.001);(2) Compared with group A, GWW of group B was significantly increased, while GWI, GWE, GCW and GLS were significantly decreased(P<0.001);(3) GWI, GWE, GCW, GWW and GLS all had high diagnostic value for predicting grade Ⅱ of reduced diastolic function. Conclusions Myocardial work parameters measured by PSL had superior predictive value for earlier changes of left ventricular systolic function than GLS in HFpEF patients under different diastolic function states, which might be expected to provide sensitive and quantify myocardial mechanics index for clinical evaluating left ventricular diastolic function in HFpEF patients.

关 键 词：超声心动图 压力-应变环 心肌做功 射血分数保留型心衰 

分 类 号：R445.1[医药卫生—影像医学与核医学] R541.6[医药卫生—诊断学]