门控心肌灌注显像评估慢性心力衰竭患者左心室机械同步性的应用及其与纽约心功能分级的关系

目的 探讨门控心肌灌注显像（GMPI）在评估慢性心力衰竭患者左心室机械同步性中的应用价值及其与纽约心功能分级的关系，分析慢性心力衰竭患者发生左心室机械同步性失调的影响因素。 方法 回顾性分析2020年1月至2021年12月在昆明医科大学附属延安医院行GMPI检查的81例慢性心力衰竭患者的临床资料，其中男性56例、女性25例，年龄（56.1±15.6）岁，同时纳入同期就诊的23名健康受检者为健康对照组，采集所有研究对象的GMPI指标包括左心室射血分数（LVEF）、高峰充盈率（PFR）、左心室收缩末期容积（LVESV）、左心室舒张末期容积（LVEDV）、相位分布标准差（PSD）、相位直方图带宽（PHB）、静息总积分（SRS）]和实验室检查结果包括超敏C反应蛋白（Hs-CRP）、N末端B型利钠肽原（NTpro-BNP）]，GMPI检查和实验室检查的时间间隔不超过7 d。通过Kruskal Wallis检验与Spearman相关性分析法分析GMPI各指标、Hs-CRP、NTpro-BNP与慢性心力衰竭患者纽约心功能分级的关系。2组间独立样本的比较采用 t 检验或Mann-Whitney U 检验，计数资料的组间比较采用卡方检验或Fisher确切概率法。通过Logistic回归分析探讨不同因素对慢性心力衰竭患者左心室机械同步性的影响。 结果 LVEF、LVEDV、LVESV、PFR、PHB、PSD、Hs-CRP、NTpro-BNP在心功能Ⅰ级组、心功能Ⅱ级组、心功能Ⅲ~Ⅳ级组间的差异均有统计学意义（H=23.846、14.791、21.089、6.251、18.892、20.347、19.171、35.654，均P<0.05）；心功能Ⅰ级组慢性心力衰竭患者与健康对照组相比，LVEF、LVEDV、LVESV、PFR、PSD、NTpro-BNP间的差异均有统计学意义（t=4.084，Z=3.462、3.038、3.519、3.489、2.203，均P<0.05）。SRS、LVESV、LVEDV、PHB、PSD、NTpro-BNP、Hs-CRP水平与纽约心功能分级呈正相关（r=0.235、0.547、0.474、0.481、0.458、0.671、0.439，均P<0.05）；LVEF、PFR与纽约心功能分级呈负相关（r=?0.563、?0.304，均P<0.05）。单因素分析结果显示，左心室机械同步与不同步的慢性心力衰竭患者的年龄、LVEF、PFR、心率、LVEDV、LVESV、SRS、Hs-CRP、NTpro-BNP比较，差异均有统计学差异（t=2.550、χ2=6.146、t=4.042、Z=3.149、χ2=5.335、χ2=5.993、Z=4.978、χ2=6.154、Z=4.381，均P<0.05）；多因素Logistic回归分析结果显示，LVEF、SRS是慢性心力衰竭患者发生左心室机械同步性失调的独立影响因素（B=?0.166、0.278，B值标准误为0.068、0.130，Wald χ2=5.927、4.584，P=0.015、0.032，OR=0.847、1.320，95%CI:0.741~0.968、1.024~1.702）。 结论 LVEF、LVEDV、LVESV、PFR、PSD、NTpro-BNP可能具有早期诊断慢性心力衰竭的潜在价值；LVEF、LVESV、PFR、LVEDV、PHB、PSD、NTpro-BNP、Hs-CRP对慢性心力衰竭患者的心功能受损严重程度有提示作用，以NTpro-BNP、LVEF、LVESV的提示作用较优；SRS水平升高、LVEF水平降低是慢性心力衰竭患者发生左心室机械同步性失调的独立预测因子。

Use of gated myocardial perfusion imaging to assess left ventricular mechanical synchrony in patients with chronic heart failure and its relationship to New York heart functional class

Objectives To investigate the application value of gated myocardial perfusion imaging (GMPI) in the evaluation of left ventricular mechanical synchrony in patients with chronic heart failure and its relationship with the New York cardiac functional class, and to analyze the influencing factors of left ventricular mechanical synchrony disorder in patients with chronic heart failure. Methods The clinical data of 81 patients with chronic heart failure admitted to Yan'an Hospital Affiliated to Kunming Medical University from January 2020 to December 2021 were selected, including 56 males and 25 females, aged (56.1±15.6) years, and 23 healthy subjects admitted during the same period were included as healthy control group. GMPI indicators (including left ventricular ejection fraction (LVEF), peak filling rate (PFR), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), phase standard deviation (PSD), phase histogram bandwidth (PHB), and summed rest score (SRS)) and laboratory tests (including hypersensitivity C-reactive protein (Hs-CRP) and N-terminal pro-B-type natriuretic peptide (NTpro-BNP)) of all subjects were collected, and the interval between GMPI examination and laboratory examination was no more than 7 days. Kruskal Wallis test and Spearman correlation analysis were used to analyze the relationship between GMPI, Hs-CRP, NTpro-BNP and classification of nyha heart function in patients with chronic heart failure. The independent samples between two groups were compared by t test or Mann-Whitney U test, and the inter-group comparison of counting data was performed by Chi-square test or Fisher exact probability method. Logistic regression analysis was conducted to explore the effects of different factors on left ventricular mechanical synchrony in patients with chronic heart failure. Results There were significant differences of LVEF, LVEDV, LVESV, PFR, PHB, PSD, Hs-CRP and NTpro-BNP in the cardiac function grade Ⅰ group, the cardiac function grade Ⅱ group and the cardiac function grade Ⅲ-Ⅳ groups (H=23.846, 14.791, 21.089, 6.251, 18.892, 20.347, 19.171, 35.654, all P<0.05). There were significant differences in LVEF, LVEDV, LVESV, PFR, PSD and NTpro-BNP between the patients with chronic heart failure in the cardiac function grade Ⅰ group and the healthy control group (t=4.084, Z=3.462, 3.038, 3.519, 3.489, 2.203; all P<0.05). The levels of SRS, LVESV, LVEDV, PHB, PSD, NTpro-BNP, Hs-CRP were positively correlated with the New York cardiac functional class (r=0.235, 0.547, 0.474, 0.481, 0.458, 0.671, 0.439; all P<0.05). Univariate analysis showed that there were statistically significant differences in age, LVEF, PFR, heart rate, LVEDV, LVESV, SRS, Hs-CRP and NTpro-BNP between patients with left ventricular mechanical synchrony and those with non-synchronous chronic heart failure (t=2.550, χ2=6.146, t=4.042, Z=3.149, χ2=5.335, χ2=5.993, Z=4.978, χ2=6.154, Z=4.381; all P<0.05); The results of multivariate regression analysis showed that LVEF and SRS were independent influencing factors for the occurrence of left ventricular mechanical synchronization dysregulation in patients with chronic heart failure (B=?0.166, 0.278; B standard error=0.068, 0.130; Wald χ2=5.927, 4.584; P=0.015, 0.032; OR=0.847, 1.320; 95%CI=0.741-0.968, 1.024-1.702). Conclusion LVEF, LVEDV, LVESV, PFR, PSD, NTpro-BNP may have potential value in early diagnosis of chronic heart failure. LVEF, LVESV, PFR, LVEDV, PHB, PSD, NTpro-BNP and Hs-CRP have suggestive effects on the severity of cardiac function impairment in patients with chronic heart failure, and NTpro-BNP, LVEF and LVESV have better suggestive effects. Increased SRS and decreased LVEF were independent predictors of left ventricular mechanical synchrony in patients with chronic heart failure.