无创左室压力应变曲线在冠心病心肌缺血诊断中的价值  

Value of non-invasive left ventricular myocardial work in the diagnosis of myocardial ischemia in coronary heart disease

作　　者：赵盈洁 何芙蓉 何玮 过伟锋 赵士海 葛振一 姚志锋 陈海燕 潘翠珍 舒先红 ZHAO Yingjie;HE Furong;HE Wei;GUO Weifeng;ZHAO Shihai;GE Zhenyi;YAO Zhifeng;CHEN Haiyan;PAN Cuizhen;SHU Xianhong(Shanghai Institute of Medical Imaging,Shanghai 200032,China;Department of Echocardiography,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Cardiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;School of Basic Medical Sciences,Fudan University,Shanghai 200032,China;Department of Vascular Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Radiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]上海市影像医学研究所,上海200032 [2]复旦大学附属中山医院心脏超声诊断科,上海200032 [3]复旦大学附属中山医院心内科,上海200032 [4]复旦大学基础医学院,上海200032 [5]复旦大学附属中山医院血管外科,上海200032 [6]复旦大学附属中山医院放射科,上海200032

出　　处：《中国临床医学》2024年第3期411-419,共9页Chinese Journal of Clinical Medicine

基　　金：上海市自然科学基金(22ZR1426000);上海市科学技术委员会项目(202140291);上海市临床重点专科项目(shslczdzk03501)

摘　　要：目的以冠状动脉血流储备分数(fraction flow reservation,FFR)为金标准,采用无创左室压力应变环(pressure strain loop,PSL)评价心肌做功相关参数对冠状动脉粥样硬化性心脏病(coronary artery disease,CAD)心肌缺血的诊断价值。方法前瞻性纳入2020年12月至2021年12月在复旦大学附属中山医院就诊的53例临床疑似CAD患者,均进行超声心动图检查、有创冠状动脉造影和FFR测量。根据冠脉造影结果将患者分为心肌缺血组(FFR≤0.8,24例)和非心肌缺血组(FFR>0.8,29例)。采用PSL进行脱机分析,获得左室整体做功指数(global work index,GWI)、整体有效功(global constructive work,GCW)、整体无效功(global wasted work,GWW)、整体做功效率(global work efficiency,GWE)、整体正向功(global positive work,GPW)及整体收缩期有效功(global systolic constructive work,GSCW)等心肌做功参数值,进行两组间比较。采用ROC曲线分析心肌做功参数对心肌缺血的诊断效能。结果在18、16和12节段水平,与非心肌缺血组相比,心肌缺血组GWI、GCW、GPW、GSCW均降低(P<0.001)。ROC曲线显示,GWI、GCW、GPW、GSCW在18节段水平AUC分别为0.803(95%CI 0.679~0.927)、0.807(95%CI 0.687~0.928)、0.822(95%CI 0.708~0.936)、0.819(95%CI 0.703~0.935)。其中,GWI最佳截断值为1676.3 mmHg%,预测心肌缺血的灵敏度、特异度和准确度分别为70.8%、86.2%和79.2%;GCW最佳截断值为1999.4mmHg%,预测心肌缺血的灵敏度、特异度和准确度分别为75.0%、82.8%和79.2%。结论采用PSL分析心肌做功对CAD心肌缺血人群有较好的筛查作用。Objective To evaluate the diagnostic value of myocardial work related parameters in coronary ischemiapatients with coronary artery disease(CAD)coronary ischemia using non-invasive leff ventricular pressure strain loop(PSL),taking fraction flow reservation(FFR)as the gold standard.MethodsFrom December 2020 to December 2021,53 clinically suspectedCAD patients were prospectively enrolled.All patients underwent echocardiography,invasive coronary angiography and FFRmeasurement.According to the results of coronary angiography,patients were divided into myocardial ischemia group(n-24,FFR≤0.80)and non-myocardial ischemia group(n=29,FFR>0.80).PSL was used for off-line analysis to obtain the global work index(GWI),global constructive work(GCW),global wasted work(GWW),global work efficiency(GWE),global positive work(GPW)and global systolic constructive work(GSCW)and other myocardial work parameters.The differences of parameter values betweenthe two groups were compared.The diagnostic efficacy of work parameters in myocardial ischemia was analyzed by ROC curve.ResultsCompared with the non-myocardial ischemia group,GWI,GCW,GPW and GSCW were significantly decreased in themyocardial ischemia group at the 18-,16-,and 12-segment levels(P<0.001).The ROC curve showed that the AUC results of GWI,GCW,GPW,GSCW at the 18-segment level were 0.803(95%CI 0.679-0.927),0.807(95%CI 0.687-0.928),0.822(95%CI 0.708-0.936),0.819(95%CI 0.703-0.935).The optimal cut-off value of GWI was 1676.3 mmHg%,and the sensitivity,specificity andaccuracy of predicting myocardial ischemia were 70.8%,86.2%and 79.2%,respectively.The optimal cut-off value of GCW was1999.4 mmHg%,and the sensitivity,specificity and accuracy of predicting myocardial ischemia were 75.0%,82.8%and 79.2%respectively.ConclusionsAnalyzing myocardial work using PSL has good significance for screening suspected myocardialischemia in CAD patients.

关 键 词：超声心动图 压力应变环 血流储备分数 冠心病 心肌缺血 

分 类 号：R543.3*1[医药卫生—心血管疾病]