无创心肌做功对左束支传导阻滞患者左心室整体及节段心肌收缩功能的评价  

No-invasive myocardial work for evaluation of global and segmental myocardial function in patients with left bundle branch block

作　　者：孙佳英[1] 黄云洲[1] 任书堂[1] 王翠华[1] 陈新华[1] 于艾嘉 陈元禄[2] Sun Jiaying;Huang Yunzhou;Ren Shutang;Wang Cuihud;Chen Xinhud;Yu Aijid;Chen Yuanlu(Department of Ultrasound,TEDA International Cardiovascular Hospital,Tianjin 300457,China;Department of Electrophysiology,TEDA International Cardiovascular Hospital,Tianjin 300457,China)

机构地区：[1]泰达国际心血管病医院超声科,天津300457 [2]泰达国际心血管病医院电生理科,天津300457

出　　处：《中华医学超声杂志（电子版）》2023年第8期836-843,共8页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的应用无创心肌做功(MW)技术评价左束支传导阻滞(LBBB)患者左心室整体及节段心肌收缩功能的特点。方法选取2019年9月至2022年5月于泰达国际心血管病医院首次就诊的真性LBBB患者42例。按左心室射血分数(LVEF)分为3组:EF保留组(LVEF≥50%,17例)、EF轻中度减低组(LVEF 36%~49%,14例)和EF重度减低组(LVEF≤35%,11例)。同时选取15例健康体检者作为对照组。测量并分析比较各组患者的左心室整体MW参数:左心室整体做功指数(GWI)、整体有用功(GCW)、整体无用功(GWW)及整体做功效率(GWE),节段MW参数:室间隔中段及左心室侧壁中段的做功指数(WI-septal、WI-lateral)、有用功(CW-septal、CW-lateral)、无用功(WW-septal、WW-lateral)及做功效率(WE-septal、WE-lateral)。并对MW参数与传统超声心动图参数的相关性进行分析。结果与对照组相比,LBBB各组GWI及GWE降低、GWW增高(P均<0.05)。LBBB各组CW-septal低于CW-lateral,WW-septal高于WW-lateral(P均<0.05)。与对照组相比,EF保留组和EF轻中度减低组WI-septal、CW-septal及WE-septal均降低,WW-septal增高(P均<0.05),而侧壁的节段MW参数仅WW-lateral有所增高(P<0.05);LBBB重度减低组WI-lateral及CW-lateral亦有所减低(P均<0.05)。整体MW参数及室间隔节段MW参数与传统超声参数均呈良好相关性,其中整体MW参数中GWE与LVEF、LVESV及GLS相关性最好(r=0.90、-0.80和0.95,P均<0.001),节段MW参数中WE-septal与LVEF、LVESV及GLS相关性最好(r=0.86、-0.76和0.86,P均<0.01)。结论MW参数可以准确详细评估LBBB患者左心室整体和节段心肌收缩功能的变化。在左心室收缩功能减低不明显的LBBB患者中,室间隔功能已有受损,左心室侧壁功能尚能保存;在左心室收缩功能严重下降的患者中,左心室侧壁收缩功能亦减低。Objective To evaluate the global and segmental systolic function of the left ventricle in patients with left bundle branch block(LBBB)by noninvasive myocardial work(MW).Methods A total of 42 patients with true LBBB who received their first treatment at TEDA International Cardiovascular Hospital from September 2019 to May 2022 were divided into three groups according to left ventricular ejection fraction(LVEF):EF preserved group(LVEF≥50%),EF moderately reduced group(LVEF=36%~49%),and EF severely reduced group(LVEF≤35%).Fifteen healthy people were selected as a control group.The following parameters were obtained and analyzed:global MW parameters including global work index(GWI),global constructive work(GCW),global wasted work(GWW),and global work efficiency(GWE),and segmental MW parameters including WI-septal,WI-lateral,CW-septal,CW-lateral,WW-septal,WW-lateral,WE-septal,and WE-lateral.The correlation between MW parameters and traditional parameters was analyzed.Results GWI and GWE were lower and GWW was higher in the LBBB groups than in the control group(P<0.05).CW-septal was lower than CW-lateral and WW-septal was higher than WW-lateral in the LBBB groups(P<0.05).Compared with the control group,WI-septal,CW-septal,and WE-septal decreased and WW-septal increased in both the EF preserved group and EF moderately reduced group(P<0.05),while only WW-lateral increased among the lateral segmental MW parameters(P<0.05).In the EF severely reduced group,WI-lateral and CW-lateral also decreased(P<0.05).Global and septal MW parameters showed a strong correlation with traditional parameters.Among global MW parameters,GWE showed the best correlation with LVEF,LVESV,and GLS(r=0.90,-0.80,and 0.95,respectively,P<0.001),while in segmental MW parameters,WE-septal showed the best correlation with LVEF,LVESV,and GLS(r=0.86,-0.76,and 0.86,respectively,P<0.01).Conclusion Myocardial work can be used to assess the global and segmental systolic function of the left ventricle in patients with LBBB in detail.When LVEF is not significan

关 键 词：超声心动描记术 左束支传导阻滞 心肌做功 

分 类 号：R542.2[医药卫生—心血管疾病]