左心室压力-应变环评估冠心病患者冠状动脉病变程度

目的 观察左心室压力-应变环（LV-PSL）评估冠心病患者冠状动脉病变程度的价值。方法 按照Gensini评分将154例冠心病患者分为轻度组（n=51）、中度组（n=53）和重度组（n=50），以50名健康志愿者作为对照组。采用LV-PSL观察并比较各组左心室整体纵向应变（GLS）及心肌做功（MW）参数，包括整体有用功（GCW）、整体无用功（GWW）、整体做功指数（GWI）及整体做功效率（GWE），分析其评估冠状动脉病变程度的效能。结果 组间GLS及MW参数差异均有统计学意义（P均<0.05）。轻度组GWW高于、而GWE低于对照组（P均<0.05）；中度组GWW高于轻度组和对照组（P均<0.05），GLS、GWI、GCW及GWE均低于轻度组和对照组（P均<0.05）；重度组GWW高于，而GLS、GWI、GCW及GWE均低于其余3组（P均<0.05）。GWE评估冠状动脉中、重度病变的曲线下面积均大于GWI、GCW及GWW （Z=0.73、0.74、0.88，P均<0.001）；以94.50%为GWE最佳截断值，其特异度为87.00%，敏感度为83.00%。Gensini评分与GWW呈中度正相关（r=0.69，P<0.01），与GWI、GCW呈低度负相关（r=－0.42、－0.43，P均<0.01），而与GWE呈中度负相关（r=－0.79，P<0.01）。结论 LV-PSL对评估冠心病患者冠状动脉病变程度具有一定价值，以左心室GWE诊断效能最佳。

Left ventricular pressure-strain loop for evaluating degree of coronary artery disease in patients with coronary heart disease

Objective To observe the value of left ventricular pressure-strain loop (LV-PSL) for evaluating the degree of coronary artery disease in patients with coronary heart disease (CHD). Methods Totally 154 CHD patients were enrolled and divided into mild group (n=51), moderate group (n=53) and severe group (n=50) according to Gensini scores, and 50 healthy volunteers were taken as controls (control group). The left ventricular global longitudinal strain (GLS) and myocardial work (MW) parameters, including global constructive work (GCW), global wasted work (GWW), global work index (GWI) and global work efficiency (GWE) were observed and compared with LV-PSL among groups, and the efficacy for evaluating the degree of coronary artery disease was analyzed. Results There were significant differences of GLS and MW parameters among groups (all P<0.05). In mild group, GWW was higher, while GWE was lower than those in control group (both P<0.05). In moderate group, GWW was higher, while GLS, GWI, GCW and GWE were lower than those in mild group and control group (all P<0.05). GWW in severe group was higher, while GLS, GWI, GCW and GWE were lower than those in the other 3 groups (all P<0.05). The area under the curve of GWE for evaluating moderate and severe coronary artery lesions in CHD patients was greater than that of GWI, GCW and GWW (Z=0.73, 0.74, 0.88, all P<0.001). Taken 94.50% as the best cutoff value of GWE, the specificity was 87.00% and the sensitivity was 83.00%. Gensini score was moderately and positively correlated with GWW (r=0.69, P<0.01), lowly negatively correlated with GWI and GCW (r=-0.42, -0.43, both P<0.01), and moderately negatively correlated with GWE (r=-0.79, P<0.01). Conclusion LV-PSL had certain value for evaluating the degree of coronary artery disease in CHD patients, and left ventricular GWE had the best diagnostic efficacy.