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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2022, Vol. 19 ›› Issue (10) : 1071 -1076. doi: 10.3877/cma.j.issn.1672-6448.2022.10.009

心血管超声影像学

无创左心室压力-应变环评价阵发性心房颤动患者左心室心肌做功的价值
李沅芝1, 李一丹1, 丁雪晏1, 郭迪晨1, 叶晓光1, 孙兰兰1, 魏丽群1, 朱维维1, 王江涛2, 吕秀章1,†()   
  1. 1. 100020　首都医科大学附属北京朝阳医院心脏超声科
    2. 100176　北京，通用电气医疗系统（中国）
  • 收稿日期:2021-02-07 出版日期:2022-10-01
  • 通信作者: 吕秀章

Application of non-invasive left ventricular pressure-strain loop in evaluating left ventricular myocardial work in paroxysmal atrial fibrillation patients

Yuanzhi Li1, Yidan Li1, Xueyan Ding1, Dichen Guo1, Xiaoguang Ye1, Lanlan Sun1, Liqun Wei1, Weiwei Zhu1, Jiangtao Wang2, Xiuzhang Lyu1,†()   

  1. 1. Department of Echocardiography, Chaoyang Hospital of Capital Medical University, Beijing 100020, China
    2. General Electric Medical System (China), Beijing 100176, China
  • Received:2021-02-07 Published:2022-10-01
  • Corresponding author: Xiuzhang Lyu
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李沅芝, 李一丹, 丁雪晏, 郭迪晨, 叶晓光, 孙兰兰, 魏丽群, 朱维维, 王江涛, 吕秀章. 无创左心室压力-应变环评价阵发性心房颤动患者左心室心肌做功的价值[J]. 中华医学超声杂志（电子版）, 2022, 19(10): 1071-1076.

Yuanzhi Li, Yidan Li, Xueyan Ding, Dichen Guo, Xiaoguang Ye, Lanlan Sun, Liqun Wei, Weiwei Zhu, Jiangtao Wang, Xiuzhang Lyu. Application of non-invasive left ventricular pressure-strain loop in evaluating left ventricular myocardial work in paroxysmal atrial fibrillation patients[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(10): 1071-1076.

目的

探讨左心室压力-应变环（PSL）评估阵发性心房颤动（PAF）患者左心室心肌做功的应用价值。

方法

选取2019年10月至2020年11月在首都医科大学附属北京朝阳医院心内科确诊的PAF患者45例，根据是否有高血压（HP）病史，将其分为PAF合并HP组25例和PAF不合并HP组20例。另选取健康志愿者20例作为对照组。采集左心室心尖三腔心、四腔心及两腔心切面动态图像，并导入EchoPAC 203工作站进行后处理分析，应用二维斑点追踪超声心动图（2D-STE）获得左心室整体纵向应变（GLS）及机械离散度（MD），GLS联合左心室压力得到PSL，测量心肌整体做功参数，包括心肌整体做功指数（GWI）、整体有效功（GCW）、整体无效功（GWW）及整体做功效率（GWE）。评价3组间各参数的差异，并分析左心室射血分数（LVEF）、MD与心肌整体做功参数之间的相关性。

结果

与对照组相比，PAF不合并HP组左心室舒张末期内径（LVDd）、左心室收缩末期内径（LVSd）增大（P均＜0.05）。与对照组相比，PAF不合并HP组MD增大，GLS、GWI及GWE减低。与PAF不合并HP组相比，PAF合并HP组MD进一步增大、GWE进一步减低；同时，PAF合并HP组GWI、GCW及GWW较PAF不合并HP组明显增加，差异均具有统计学意义（P均＜0.05）。PAF患者LVEF与GWI、GWE、GCW呈正相关（r=0.452，P=0.002；r=0.369，P=0.014；r=0.382，P=0.010）；MD与GWE呈负相关（r=-0.629，P＜0.001）、与GWW呈正相关（r=0.317，P=0.034）。

结论

PSL可定量评估PAF患者左心室心肌做功情况，较GLS能更全面反映PAF患者左心室心肌收缩功能改变情况，为临床诊断和疾病管理提供依据。

关键词: 超声心动图, 心房颤动, 心肌做功, 心室功能，左
Objective

To assess the value of pressure-strain loop (PSL) in evaluating left ventricular myocardial work (MW) in patients with paroxysmal atrial fibrillation (PAF).

Methods

A total of 45 patients with PAF diagnosed at the Department of Cardiology, Beijing Chaoyang Hospital Affiliated to Capital Medical University from October 2019 to November 2020 were included. According to whether the patients had a history of hypertension, they were divided into either a PAF with hypertension (HP) group (25 cases) or a PAF without HP group (20 cases). Another 20 healthy volunteers were selected as controls. Dynamic images of left ventricular apical three-chamber, four-chamber, and two-chamber views were collected and imported into EchoPAC 203 workstation for analysis. Two-dimensional speckle tracking echocardiography (2D-STE) was used to obtain the global longitudinal strain (GLS) and mechanical dispersion (MD) of the left ventricle. The PSL was obtained based on GLS combined with left ventricular pressure. The global myocardial work parameters were measured, which included GWI (global work index), GCW (global constructive work), GWW (global wasted work), and GWE (global work efficiency). The differences of these parameters among the three groups were evaluated, and the correlation of left ventricular ejection fraction (LVEF) and MD with myocardial global work parameters was analyzed.

Results

Compared with the control group, left ventricular end diastolic menstruation and left ventricular end systolic diameter increased in the PAF without HP group (P<0.05). Compared with the control group, MD increased, and GLS, GWI, and GWE decreased in the PAF without HP group. Compared with the PAF without HP group, MD further increased and GWE further decreased in the PAF with HP group. Meanwhile, GWI, GCW, and GWW in the PAF with HP group increased significantly compared with those of the PAF without HP group (P<0.05). Among PAF patients, LVEF was positively correlated with GWI, GWE, and GCW (r=0.452, P=0.002; r=0.369, P=0.014; r=0.382, P=0.010); MD was negatively correlated with GWE (r=-0.629, P<0.001) and positively correlated with GWW (r=0.317, P= 0.034).

Conclusion

PSL can quantitatively evaluate the work of left ventricular myocardium in PAF patients. It can more comprehensively reflect the changes in left ventricular myocardial systolic function in PAF patients than GLS, providing a basis for clinical diagnosis and disease management.

Key words: Echocardiography, Atrial fibrillation, Myocardial work, Ventricular function, left
表1 3组间一般资料及常规超声心动图参数比较（
xˉ
±s）
组别 例数 LVDd（mm） LVSd（mm） IVST（mm） LVPWT（mm） E/e' LVEF（%）
PAF合并HP组 25 46.6±4.3a 27.9±3.0a 10.4±1.3ab 9.5±1.0a 8.8±3.3 59.6±4.1
PAF不合并HP组 20 46.5±3.8a 28.9±3.4a 9.5±1.1 9.0±1.1 7.3±2.5 60.1±6.1
对照组 20 43.2±3.3 25.8±3.0 9.0±0.9 8.6±0.8 7.9±1.8 62.8±4.1
F值 5.262 5.557 9.757 5.726 1.741 2.628
P值 0.008 0.006 ＜0.001 0.005 0.184 0.080
组别 例数 男性［例（%）］ 年龄（岁） BSA（m2） 收缩压（mmHg） 舒张压（mmHg）
PAF合并HP组 25 16（70） 64.3±8.5 1.87±0.18a 149.0±16.0ab 78.8±10.9ab
PAF不合并HP组 20 12（60） 62.6±7.1 1.79±0.15 120.6±10.0 69.5±9.4
对照组 20 14（64） 62.1±4.3 1.71±0.14 118.6±10.8 69.8±7.2
F值/χ2值 6.00 0.607 5.518 40.394 7.208
P值 0.199 0.548 0.006 ＜0.001 0.002
表2 3组间心肌做功参数及应变参数比较（
xˉ
±s）
组别 例数 GLS（-%） MD（ms） GWI（mmHg%） GWE（%） GCW（mmHg%） GWW（mmHg%）
PAF合并HP组 25 17.4±2.7a 73.2±29.9ab 1931.3±452.5b 89.1±5.3ab 2396.5±483.2b 254.6±161.1ab
PAF不合并HP组 20 18.6±2.6a 56.4±20.2a 1667.4±313.0a 93.2±2.4a 2007.4±340.0 123.9±55.1
对照组 20 20.8±1.8 40.4±9.9 1916.7±191.3 96.0±1.3 2169.0±266.9 75.0±33.3
F值 10.922 11.963 3.816 20.710 5.836 17.446
P值 ＜0.001 ＜0.001 0.027 ＜0.001 0.005 ＜0.001
图1 健康志愿者左心室心肌做功参数图像注：GLS为左心室整体纵向应变峰值；GWI为整体做功指数；GWE为整体做功效率；GCW为整体有效功；GWW为整体无效功；BP为血压
图2 阵发性心房颤动不合并高血压患者左心室心肌做功参数图像注：GLS为左心室整体纵向应变峰值；GWI为整体做功指数；GWE为整体做功效率；GCW为整体有效功；GWW为整体无效功；BP为血压
图3 阵发性心房颤动合并高血压患者左心室心肌做功参数图像注：GLS为左心室整体纵向应变峰值；GWI为整体做功指数；GWE为整体做功效率；GCW为整体有效功；GWW为整体无效功；BP为血压
表3 心肌做功参数与LVEF、MD之间的相关性
参数 LVEF MD
r值 P值 r值 P值
GWI 0.452 0.002 -0.269 0.074
GWE 0.369 0.014 -0.629 ＜0.001
GCW 0.382 0.010 -0.238 0.115
GWW -0.199 0.196 0.317 0.034
表4 左心室心肌做功参数观察者内及观察者间一致性分析
参数 观察者间 观察者内
ICC 95%CI ICC 95%CI
GWI 0.523 0.656~0.863 0.867 0.536~0.962
GWE 0.874 0.498~0.997 0.827 0.398~0.950
GCW 0.830 0.408~0.951 0.906 0.674~0.973
GWW 0.737 0.387~0.924 0.980 0.931~0.994
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