压力-应变环评价心脏淀粉样变左心室心肌做功的价值  

Evaluation of myocardial work of left ventricle in patients with cardiac amyloidosis by pressure-strain loop

作　　者：张音佳[1] 金佳美[1] 邢雨蒙 王海尔[1] 王燕[1] 钟春燕[1] 陈林[1] ZHANG Yin-jia;JIN Jia-mei;XING Yu-meng;WANG Hai-er;WANG Yan;ZHONG Chun-yan;CHEN Lin(Department of Ultrasound,Huadong Hospital Affiliated to Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华东医院超声医学科,上海200040

出　　处：《中国临床医学影像杂志》2024年第6期418-422,433,共6页Journal of China Clinic Medical Imaging

基　　金：上海市级医院老年医学科临床能力促进与提升专科联盟项目(SDHC22023302)。

摘　　要：目的:探讨压力-应变环评价不同左心室射血分数(Left ventricular ejection fraction,LVEF)的心脏淀粉样变(Cardiac amyloidosis,CA)患者左心室心肌做功的价值。方法:回顾性分析23例CA患者(CA1组16例,LVEF≥50%;CA2组7例,LVEF<50%)和25例健康受试者(对照组)基于二维斑点追踪技术的压力-应变环左心室心肌做功参数的差异。结果:①CA1组、CA2组与对照组比较,左心室整体纵向应变(Global longitudinal strain,GLS)、整体做功指数(Global work index,GWI)、整体有效功(Global constructive work,GCW)、整体做功效率(Global work efficiency,GWE)降低(P<0.05),GLS达峰时间离散度(Peak strain dispersion,PSD)、整体无效功(Global wasted work,GWW)增高(P<0.05);CA2组与CA1组比较,GLS、GWE降低(P<0.05),GWW增高(P<0.05)。②CA1组、CA2组与对照组比较,基底段和心尖段纵向应变(Longitudinal strain,LS)、心肌做功指数(Myocardial work index,MWI)、心肌有效功(Myocardial constructive work,MCW)、心肌做功效率(Myocardial work efficiency,MWE)均降低(P<0.05),CA2组心尖段无效做功(Myocardial wasted work,MWW)较对照组及CA1组增加(P<0.05)。CA1组LS、MWI、MCW、MWE具有相对“心尖保留”模式,CA2组MWI、MCW、MWE无“心尖保留”模式。③GLS、GWW、心尖段MWW、MWW心尖/基底与LVEF呈负相关,GWE、心尖段MWE与LVEF呈正相关(P<0.05)。影响CA患者LVEF的主要因素为心尖段MWW及GLS(P<0.05)。结论:CA患者左心室整体及节段心肌做功减低,左心室心尖段MWW及GLS是影响CA患者LVEF的重要因素。左心室压力-应变环有望成为评价CA患者左心室心肌做功便捷、无创的影像学新方法。Objective:To explore the value of pressure-strain loop(PSL)in evaluating myocardial work of left ventricle in patients with cardiac amyloidosis(CA)with different left ventricular ejection fraction(LVEF).Methods:Twenty-three patients with CA(Group CAl,16 cases,LVEF≥50%;Group CA2,seven cases,LVEF<50%)and 25 healthy subjects(control group)were enrolled.The difference of left ventricular longitudinal strain(LS)and myocardial work among groups were analyzed by PSL based on two-dimensional speckle tracking imaging.Results:Compared to the control group,global longitudinal strain(GLS),global work index(GWI),global constructive work(GCW)and global work efficiency(CWE)were decreased in group CA1 and group CA2(P<0.05).Peak strain dispersion(PSD)and global wasted work(GWW)of left ventricle were increased in group CA1 and group CA2 compared to the control group(P<0.05).GLS and GWE were lower in group CA2 than in group CA1(P<0.05)while GWW was higher in group CA2 than in group CA1(P<0.05).②LS,myocardial work index(MWI),myocardial con-structive work(MCW).and myocardial work efficiency(MWE)in basal and apical segments were decreased in group CA1 and group CA2 compared to control group,myocardial wasted work(MWW)in apical segments were higher in group CA2 than group CA1 and control group(P<0.05).Relative apical sparing patterns of LS,MWI,MCW,and MWE were found in group CAI1.However,this pattern was not found in MWI,MCW and MWE in group CA2.③CLS,GWW,and MWW in apical seg-ments,apical-to-base ratio of MWW had negative correlations with LVEF(P<0.05),while CWE and MWE in apical segments had positive correlations with LVEF(P<0.05).The major factors influenced LVEF were MWW in apical segments and CLS.Conclusion:The global and regional myocardial work are decreased in patients with CA.MWW in apical segments and CLS have a significant effect on LVEF.PSL is of great value to evaluate the myocardial work of left ventricle in patients with CA.

关 键 词：心脏病 淀粉样变性 心室功能 左 超声心动描记术 

分 类 号：R541[医药卫生—心血管疾病] R540.45[医药卫生—内科学]