冠状动脉微血管功能障碍对非梗阻性冠心病患者心脏力学指标的影响  

Effect of coronary microvascular dysfunction on cardiac mechanical indices in patients with non-obstructive coronary artery disease

作　　者：刘权德 潘继琛 李昕昊 张瑜[1] 李萌萌 徐铭俊[1] 张梅[1] Liu Quande;Pan Jichen;Li Xinhao;Zhang Yu;Li Mengmeng;Xu Mingjun;Zhang Mei(Department of Cardiology,Qilu Hospital of Shandong University,Jinan 250012,China)

机构地区：[1]山东大学齐鲁医院心内科,济南250012

出　　处：《中华超声影像学杂志》2022年第12期1021-1027,共7页Chinese Journal of Ultrasonography

基　　金：国家重点研发计划 (2016YFC1300302)。

摘　　要：目的:初步探讨在静息状态下,冠状动脉微血管功能障碍(CMD)对非梗阻性冠心病(NOCAD)患者心脏力学指标的影响。方法:本研究为单中心回顾性研究。选取2017年7月至2022年3月在山东大学齐鲁医院就诊的79例NOCAD患者,所有受检者均行常规经胸超声心动图检查和经胸多普勒冠状动脉血流速度储备检查(TTDE-CFVR),根据TTDE-CFVR结果将患者分为CMD组[冠状动脉血流速度储备(CFVR)<2.5,32例]及对照组(CFVR≥2.5,47例);将冠状动脉左前降支支配区的心脏局部做功指数(RWI)、长轴应变(RLS)作为左心局部力学功能指标,测量左心室整体长轴应变(GLS)、整体心内膜心肌纵向应变(GLS-endo)、整体心外膜心肌纵向应变(GLS-epi)、整体做功指数(GWI)、整体有用功(GCW)、整体无用功(GWW)、整体做功效率(GWE)作为左心室整体力学指标,分析并比较两组间的差异,采用二元Logistic回归分析局部和整体力学指标对CMD的预测价值,采用ROC曲线构建CMD的预测模型。结果:CMD组与对照组间性别比例、体质指数(BMI)、吸烟史、糖尿病史、高血压病史、血脂异常病史差异无统计学意义(均P>0.05);与对照组相比,CMD组年龄更大,RWI、GWI、GCW及GWE明显减低,RLS及GLS、GLS-endo、GLS-epi绝对值减低,差异有统计学意义(均P<0.05)。Logistic回归分析结果显示,GLS绝对值减低是合并CMD的独立危险因素(OR=1.335,95%CI=1.041~1.713,P=0.023)。ROC曲线显示,心肌应变相关指标对CMD具有较好的诊断价值。结论:NOCAD患者CMD的存在与左心室局部和整体力学功能异常降低相关。Objective To investigate the effect and relationship of coronary microvascular dysfunction(CMD)on cardiac mechanical indices in patients with non-obstructive coronary artery disease(NOCAD)in the resting state.Methods This study was a single-center retrospective study.Seventy-nine NOCAD patients who hospitalized in Qilu Hospital of Shandong University from July 2017 to March 2022 were recruited.All patients underwent conventional echocardiography examination and the examination of coronary flow velocity reserved by transthoracic Doppler echocardiography(TTDE-CFVR).Based on the results of TTDE-CFVR,patients were divided into CMD group(CFVR<2.5,32 cases)and a control group(CFVR≥2.5,47 cases).Clinical data,routine echocardiographic parameters,regional mechanical indices including regional myocardial work index(RWI)and regional longitudinal strain(RLS),global mechanical indices including left ventricular global longitudinal strain(GLS),global longitudinal strain in the endocardial layer(GLS-endo),global longitudinal strain in the epicardial layer(GLS-epi),left ventricular global work index(GWI),global contractive work(GCW),global waste work(GWW),global work efficiency(GWE)were compared between two groups.Binary logistic regression was used to analyze the risk factors of CMD.ROC curve was used to construct a prediction model for CMD.Results There was no significant difference in sex ratio,BMI,smoking history,diabetes,hypertension and dyslipidemia between CMD group and control group.Age was significantly higher in the CMD group than in the control group.RWI,GWI,GCW,GWE and the absolute values of RLS,GLS,GLS-endo and GLS-epi were significantly lower in the CMD group than in the control group.Logistic regression analysis showed that the decrease of absolute value of GLS was an independent risk factor for the CMD(OR=1.335,95%CI=1.041-1.713,P=0.023).ROC curve showed that myocardial strain-related indexes had a good decrease value for the CMD.Conclusions For patients with NOCAD,the presence of CMD is associated with the de

关 键 词：冠状动脉血流速度储备 冠状动脉微循环功能障碍 左心室收缩功能 心肌做功指数 长轴应变 

分 类 号：R541.4[医药卫生—心血管疾病]