心肌做功技术对LVEF保留的AMI患者左心室整体收缩功能降低的诊断价值

目的探讨心肌做功技术对左心室射血分数(LVEF)保留的急性心肌梗死(AMI)患者左心室整体收缩功能降低的诊断价值。方法本研究为前瞻性病例-对照设计的诊断性试验。选取2019年5—10月在河南省人民医院确诊为AMI且LVEF>50%的患者为AMI(LVEF>50%)组,并选取同期健康体检者作为对照组。收集所有研究对象的年龄、性别等一般临床资料,采用二维超声采集其心尖二腔、三腔及四腔长轴切面连续3个心动周期动态图像,测量并比较两组间常规超声心动图指标及心肌做功各参数的差异。采用组内相关系数(ICC)评价观察者内及观察者间心肌做功各参数的重复性。采用受试者工作特征(ROC)曲线分析左心室整体有用功(GCW)、整体无用功(GWW)、整体做功效率(GWE)、整体做功指数(GWI)对于LVEF保留的AMI患者左心室整体收缩功能降低的诊断价值。结果AMI(LVEF>50%)组30例,年龄(67.3±9.7)岁,女性14例(46.7%)。对照组30例,年龄(68.1±8.6)岁,女性12例(40.0%)。AMI(LVEF>50%)组左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、室间隔厚度(IVSD)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、二尖瓣口舒张早期峰值流速比二尖瓣后叶瓣环组织多普勒速度(E/e)、左心室质量(LVM)、左心室质量指数(LVMI)较对照组大,E、e较对照组低,差异均有统计学意义(P<0.05)。与对照组相比,AMI(LVEF>50%)组GCW(1145.9±440.1)mmHg%(1 mmHg=0.133 kPa)比(1425.7±355.4)mmHg%]、GWE(80.9±9.5)%比(87.3±5.5)%]、GWI(1001.3±416.2)mmHg%比(1247.6±341.7)mmHg%]低,长轴整体应变(GLS)绝对值低(8.5±3.4)%比(11.4±3.7)%],峰值应变离散度(PSD)高(101.3±66.4)ms比(74.7±31.9)ms],差异均有统计学意义(P<0.05);AMI(LVEF>50%)组GWW高(177.2±71.1)mmHg%比(155.7±64.6)mmHg%],但差异无统计学意义(P>0.05)。GCW、GWW、GWE、GWI在观察者内及观察者间的重复性良好(ICC均>0.75)。ROC曲线分析显示,GCW、GWW、GWE、GWI 4个参数曲线下面积分别为0.896、0.929、0.808、0.862,均可用于AMI(LVEF>50%)患者左心室收缩功能降低的诊断。结论心肌做功技术对于LVEF保留的AMI患者左心室整体收缩功能降低具有一定的诊断价值。

The value of myocardial work in detecting the reduction of left ventricular global systolic function in acute myocardial infarction patients with preserved ejection fraction

Objective To investigate the diagnosis value of myocardial work(MW)in evaluating left ventricular global systolic function among acute myocardial infarction(AMI)patients with preserved ejection fraction(LVEF).Methods This study was a diagnostic trial in a prospective case-control design.AMI patients with preserved LVEF were enrolled as AMI(LVEF>50%)group and age and sex-matched healthy individuals undergoing healthy checkup in our hospital were collected as control group.Two-dimensional dynamic images,including standard apical two-chamber,long-axis and four-chamber views in 3 consecutive cardiac cycles were acquired.General clinical data,routine echocardiography and myocardial work parameters were obtained from all subjects.The indices were compared between the two groups.Intra-observer and inter-observer repeatability of myocardial work parameters were evaluated by intra-group correlation coefficient(ICC).Receiver operator characteristic(ROC)curve was used to determine the diagnostic value of global constructive work(GCW),global wasted work(GWW),global work efficiency(GWE)and global work index(GWI)on the reduction of left ventricular global systolic function in AMI(LVEF>50%)group.Results There were 30 patients in AMI(LVEF>50%)group,the age was(67.3±9.7)years,and 14 cases were female(46.7%).Thirty participants were included in the control group,the age was(68.1±8.6)years,and 12 cases were female(40.0%).Compared with the control group,left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),interventricular septum thickness(IVSD),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),peak early diastolic velocity of mitral orifice/tissue Doppler velocity of posterior mitral annulus(E/e),left ventricular mass(LVM),left ventricular mass index(LVMI)were significantly higher,while E and e values were significantly lower in AMI(LVEF>50%)group(all P<0.05).Compared with the control group,GCW((1145.9±440.1)mmHg%(1 mmHg=0.133 kPa)vs.(1425.7±355.4)mmHg%),GWE((80.9±9.5)%vs.(87.3±5.5)%),GWI((1001.3±416.2)mmHg%vs.(1247.6±341.7)mmHg%)and the absolute value of long axis integral strain(GLS)((8.5±3.4)%vs.(11.4±3.7)%)were significantly lower,while peak strain dispersion(PSD)((101.3±66.4)ms vs.(74.7±31.9)ms)was significantly higher in AMI(LVEF>50%)group(P all<005).There was no significant difference in GWW((177.2±71.1)mmHg%vs.(155.7±64.6)mmHg%)between the two groups(P>0.05).The reproducibility of GCW,GWW,GWE and GWI within and between observers were satisfactory(all ICC>0.75).ROC curve analysis showed that all four parameters,GCW,GWW,GWE,and GWI,could be used for the diagnosis of reduced left ventricular systolic function in patients with AMI(LVEF>50%),and their areas under the ROC curve were 0.896,0.929,0.808,0.862.Conclusion Myocardial work assessment is valuable on diagnosing left ventricular global systolic function reduction in AMI patients with preserved LVEF.