药物负荷超声心动图评估缺血伴非阻塞性冠状动脉疾病患者左心功能  

Echocardiographic assessment of left ventricular and atrial function in patients with ischemia with nonobstructive coronary artery disease under drug stress

作　　者：佟琳 梁重霄 付启航 张赫展 张冬雪 赵欣怡 徐卉[1] Tong Lin;Liang Chongriao;Fu Qihang;Zhang Hezhan;Zhang Dongrue;Zhao Xinyi;Xu Hui(Department of Ultrasound Diagnostic Center,the First Bethune Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学白求恩第一医院超声诊断中心,长春130021

出　　处：《中华超声影像学杂志》2024年第11期966-974,共9页Chinese Journal of Ultrasonography

基　　金：吉林省科技厅项目(20210101260JC)。

摘　　要：目的在药物负荷下应用超声斑点追踪显像及左心室压力-应变环技术评估冠状动脉微血管功能障碍(CMD)对缺血伴非阻塞性冠状动脉疾病(INOCA)患者左心功能的影响。方法前瞻性收集2022年5月至2023年10月于吉林大学白求恩第一医院心内科就诊的INOCA患者43例,并进行药物负荷试验。通过经胸超声冠状动脉血流显像技术获得冠脉血流速度储备(CFVR)数值,将CFVR<2.0的患者分为CMD组(n=24),CFVR≥2.0的患者分为病例对照组(CON组,n=19);另选取20例临床资料相匹配的无胸痛健康人作为健康对照组(NEG组)。比较各组间一般临床资料,负荷前后常规超声心动图、左心房应变和左心室心肌做功参数的差异。对组内参数进行相关性分析、应用ROC曲线评估超声参数对INOCA的诊断价值。结果与CON组和NEG组相比,CMD组二尖瓣口舒张早期血流峰值与舒张晚期血流峰值比值(E/A)减低,二尖瓣口舒张早期速度E峰与二尖瓣环舒张早期速度e′比值(E/e′)增高,差异有统计学意义(均P<0.05)。CON组与CMD组负荷前后左心房应变参数左心房储备期应变(LASr)、左心房管道期应变(LAScd)、左心房收缩期应变(LASct)差异有统计学意义(均P<0.05)。CON组与CMD组心肌做功参数心肌整体纵向应变(GLS)、峰值应变离散度(PSD)、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)仅负荷后差异有统计学意义(均P<0.05),静息时差异无统计学意义(均P>0.05)。CMD组和CON组E/e′与LASr、LAScd呈负相关(r_(s)=-0.36、r=-0.31,均P<0.05),GLS与GWI、GCW、GWE呈正相关(r=0.81、0.61、0.37,均P<0.05);负荷状态下GLS与GWI、GCW、GWE呈正相关(r=0.66、0.51、0.52,均P<0.05),与GWW呈负相关(r_(s)=-0.39,P<0.05);PSD与GWW呈正相关(r_(s)=0.30,P<0.05),与GWI、GCW、GWE呈负相关(r=-0.46、-0.40、-0.38,均P<0.05)。单因素回归分析显示,左心房应变和心肌做功相关指标对CMD有较好的预测价�Objective To evaluate the effect of coronary microvascular dysfunction(CMD)on left atrial and ventricular function in patients with ischemia and non-obstructive coronary artery disease(INOCA)under the drug stress of regadenoson by speckle tracking imaging and left ventricular pressure-strain ring ultrasound technology.Methods A total of 43 patients with INOCA who were admitted to the Department of Cardiology of the First Bethune Hospital of Jilin University from May 2022 to October 2023 were prospectively enrolled,and drug stress tests were performed.The coronary flow velocity reserve(CFVR)values were obtained by transthoracic Doppler echocardiography,and the INOCA patients with CFVR<2.0 were assigned to the CMD group(n=24),and those with CFVR≥2.0 were assigned to the contrast group(CON group,n=19),and 20 healthy people without chest pain matched by clinical data were selected as the negative group(NEG group).The differences in general clinical data,routine echocardiography before and after stress,left atrial strain,and myocardial work parameters were compared between the groups.The correlation analysis of intra-group parameters was performed,and then the ROC curve was used to evaluate the diagnostic value of ultrasound parameters for INOCA.Results Compared with the CON group and the NEG group,the ratio of early diastoic velocity E peak of mitral value orifice to the late diastoic velocity A peak(E/A)decreased and the ratio of early diastoic velocity E peak of mitral valve orifice to the early diastoic velocity e′of the mitral valve annulus(E/e′)increased in the CMD group,and the differences were statistically signnificant(all P<0.05).There were statistically significant differences in left atrial strain parameters including left atrial strain reservoir(LASr),left atrial conduit strain(LAScd),left atrial contraction strain(LASct)between CON group and CMD group before and after stress(all P<0.05).However,there were no statistically significant differences between CON group and CMD group in myocardial work pa

关 键 词：超声心动描记术 缺血伴非阻塞性冠状动脉疾病 冠状动脉微血管功能障碍 心肌做功 左心房应变 

分 类 号：R540.45[医药卫生—心血管疾病] R543.3[医药卫生—内科学]