左室压力-应变环结合峰值应变离散度评价HFpEF患者的左室收缩功能及同步性  

Evaluating left ventricular systolic function and synchronicity in patients with HFpEF using left ventricular pressure-strain loop combined with peak strain dispersion

作　　者：郑丹 谭静[2] 周海燕 谢青[2] 李伟 ZHENG Dan;TAN Jing;ZHOU Haiyan;XIE Qing;LI Wei(Department of Cardiovascular Medicine,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China;The Cardiac Function Room,Department of Cardiovascular Medicine,Guizhou Provincial People's Hospital,Guiyang 550002,Guizhou,China)

机构地区：[1]贵州医科大学附属医院心血管内科,贵州贵阳550004 [2]贵州省人民医院心内科心功能室,贵州贵阳550002

出　　处：《贵州医科大学学报》2024年第3期443-449,共7页Journal of Guizhou Medical University

基　　金：贵州省卫生健康委基金项目(黔卫健函〔2021〕160)。

摘　　要：目的应用左室压力-应变环结合峰值应变离散度,结合左室心肌做功参数及峰值应变离散度(PSD)评估射血分数保留型心衰(HFpEF)患者左室收缩功能及同步性的改变。方法选择符合HFpEF诊断的患者73例作为HFpEF组,同期门诊体检健康者68例作为对照组,采集心尖四腔心、心尖长轴及心尖两腔心连续3个心动周期动态图像,应用二维斑点追踪技术得到左室整体纵向应变(Avg GLS)、峰值应变离散度(PSD),输入患者实时血压获得心肌做功指标,包括整体做功指数(GWI)、整体做功效率(GWE)、整体有效功(GCW)以及整体无效功(GWW);分析两组间各参数的差异,探讨GWE、GLS、PSD对HFpEF患者的诊断价值。结果HFpEF组患者的Avg GLS、GWI、GCW及GWE较对照组减低,PSD和GWW较对照组增高(P<0.05);相关性分析显示,HFpEF组PSD与Avg GLS、GWE呈负相关(r=-0.366,-0.417,P<0.05),GWE与Avg GLS呈正相关(r=0.329,P<0.05);GWE、GWW及Avg GLS在预测HFpEF患者左室收缩功能障碍方面呈现出较好的诊断性能,曲线下面积(AUC)分别为0.853、0.840、0.861;3种参数(GLS+GWE+PSD)联合诊断HFpEF的AUC较大,为0.937,敏感性94.52%,特异性82.35%。结论心肌做功参数及峰值应变离散度能早期、敏感地检出HFpEF患者的收缩功能及同步性改变,Avg GLS、GWE及PSD的联合应用可提升对HFpEF的诊断性能。Objective To evaluate the alterations of left ventricular systolic function and synchronicity in patients with heart failure with preserved ejection fraction(HFpEF)using left ventricular pressure-strain loop combined with peak strain dispersion(PSD),left ventricular myocardial work parameters and PSD.Methods A total of 73 patients who met the diagnosis of HFpEF were selected as HFpEF group,and 68 healthy individuals who underwent physical examinations during the same period were selected as control group.Dynamic images of apical four chamber heart,apical long axis,and apical two chamber heart were collected for three consecutive cardiac cycles.Global longitudinal strain(GLS)and PSD were captured using two-dimensional speckle tracking technique.Real-time blood pressure of the patients was inputted to obtain myocardial work indicators,including global work index(GWI),global work efficiency(GWE),global constructive work(GCW),and global wasted work(GWW).The differences in various parameters were analyzed between two groups.The diagnostic values of GWE,GLS,and PSD were explored for patients with HFpEF.Results When compared to control group,GLS,GWI,GCW,and GWE in HFpEF group were decreased,while PSD and GWW were increased(P<0.05).Correlation analysis showed that PSD in HFpEF group was negatively correlated with GLS and GWE(r=-0.366,-0.417,P<0.05),while GWE was positively correlated with GLS(r=0.329,P<0.05).GWE,GWW and GLS exhibited good diagnostic performance in predicting left ventricular systolic dysfunction in the patients with HFpEF,with areas under the curve(AUCs)of 0.853,0.840,and 0.861,respectively.The combined diagnosis of HFpEF using three parameters(GLS+GWE+PSD)had a AUC of 0.937,sensitivity of 94.52% and specificity of 82.35%.Conclusion Cardiac work parameters and peak strain dispersion can early and sensitively detect the alterations of systolic function and synchronous changes in HFpEF patients.The combined use of GLS,GWE and PSD can improve the performance in diagnosing HFpEF.

关 键 词：超声心动图 射血分数保留的心衰 压力-应变环 心肌做功 峰值应变离散度 

分 类 号：R445[医药卫生—影像医学与核医学]