左心室四维心肌应变与冠心病CABG心功能改善的关系及预测价值分析  

Relationship between left ventricular four-dimensional myocardial strain and improvement of cardiac function in patients with coronary heart disease after coronary artery bypass grafting and its predictive value

作　　者：陈红[1] 罗福雪 CHEN Hong;LUO Fu-xue(Department of Ultrasound Medicine,Bishan Hospital Affiliated to Chongqing Medical University,Chongqing 402760,China)

机构地区：[1]重庆医科大学附属璧山医院超声医学科,重庆402760

出　　处：《河北医科大学学报》2025年第3期267-273,共7页Journal of Hebei Medical University

基　　金：重庆市基础与前沿研究计划项目(Y20201210210)。

摘　　要：目的分析左心室四维心肌应变与冠心病患者冠状动脉旁路移植术(coronary artery bypass grafting,CABG)术后心功能改善的关系及预测价值。方法选取重庆医科大学附属璧山医院择期行CABG的冠心病患者120例,统计术后6个月心功能改善情况,据此分为改善组(心功能改善)和未改善组(心功能未改善)。比较2组术前左心功能指标[左心室射血分数(left ventricular ejection fraction,LVEF)、左心房面积(left atrial area,LAA)、舒张末期左心室内径(left ventricular end diastolic diameter,LVEDD)、左心室质量指数(left ventricular mass index,LVMI)]、左心室四维心肌应变参数[整体长轴应变(global longitudinal strain,GLS)、整体圆周应变(global circumferential strain,GCS)、整体径向应变(global radial strain,GRS)、整体面积应变(global area strain,GAS)],分析术前左心室四维心肌应变参数与冠心病患者CABG术后心功能改善情况的关联性,并分析术前左心室四维心肌应变参数预测冠心病患者CABG术后心功能改善的价值。结果冠心病患者CABG术后6个月心功能改善84例,心功能改善率为70.00%;未改善组术前LVEF、GRS低于改善组,LVEDD、LVMI、GLS、GCS、GAS高于改善组(P<0.05);术前GLS(OR=1.330,95%CI:1.123~1.576)、GCS(OR=1.195,95%CI:1.075~1.328)、GRS(OR=0.879,95%CI:0.815~0.947)、GAS(OR=1.221,95%CI:1.102~1.352)与术后心功能改善存在显著关联性(P<0.05);术前GLS、GCS、GRS、GAS、LVEF、LVEDD、LVMI预测术后心功能改善的曲线下面积(area under the curve,AUC)分别为0.761(95%CI:0.675~0.834)、0.757(95%CI:0.671~0.831)、0.758(95%CI:0.671~0.831)、0.755(95%CI:0.668~0.829)、0.759(95%CI:0.673~0.833)、0.757(95%CI:0.670~0.831)、0.751(95%CI:0.664~0.826),术前GLS、GCS、GRS、GAS与LVEF、LVEDD、LVMI预测术后心功能改善的AUC比较,差异无统计学意义(P>0.05);术前GLS、GCS、GRS、GAS联合预测冠心病患者CABG术后心功能改善的AUC为0.896(95%CI:0.828~0.945),大于术前GLS、GCS�Objective To analyze the relationship between left ventricular four-dimensional myocardial strain and cardiac function improvement after coronary artery bypass grafting(CABG)in patients with coronary heart disease(CHD)and its predictive value.Methods A total of 120 patients with CHD who underwent elective CABG at Bishan Hospital Affiliated to Chongqing Medical University were selected.The improvement of cardiac function at 6 months after surgery was statistically analyzed,and the patients were divided into the improvement group(with improved cardiac function)and the non-improvement group(without improvement in cardiac function).The preoperative left ventricular function indicators[left ventricular ejection fraction(LVEF),left atrial area(LAA),left ventricular end-diastolic diameter(LVEDD),left ventricular mass index(LVMI)]and left ventricular four-dimensional myocardial strain parameters[global longitudinal strain(GLS),global circumferential strain(GCS),global radial strain(GRS),global area strain(GAS)]were compared between the two groups.The correlation between preoperative left ventricular four-dimensional myocardial strain parameters and postoperative cardiac function improvement in patients with CHD undergoing CABG was analyzed,and the value of preoperative left ventricular four-dimensional myocardial strain parameters in predicting postoperative cardiac function improvement in patients with CHD undergoing CABG was also analyzed.Results In patients with CHD who underwent CABG,84 patients showed improvement in cardiac function at 6 months after surgery,with an improvement rate of 70.00%.The preoperative LVEF and GRS were lower in the non-improvement group than in the improvement group,while LVEDD,LVMI,GLS,GCS,and GAS were higher in the non-improvement group than in the improvement group(P<0.05).Preoperative GLS(OR=1.330,95%CI:1.123-1.576),GCS(OR=1.195,95%CI:1.075-1.328),GRS(OR=0.879,95%CI:0.815-0.947),and GAS(OR=1.221,95%CI:1.102-1.352)were significantly associated with postoperative cardiac function improveme

关 键 词：冠心病 冠状动脉旁路移植术 四维心肌应变 

分 类 号：R541.4[医药卫生—心血管疾病]