首页|无创左室压力应变曲线在冠心病心肌缺血诊断中的价值

无创左室压力应变曲线在冠心病心肌缺血诊断中的价值

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原文链接
  • 国家科技期刊平台
  • NETL
  • NSTL
  • 万方数据
目的 以冠状动脉血流储备分数(fraction flow reservation,FFR)为金标准,采用无创左室压力应变环(pressure strain loop,PSL)评价心肌做功相关参数对冠状动脉粥样硬化性心脏病(coronary artery disease,CAD)心肌缺血的诊断价值.方法 前瞻性纳入2020年12月至2021年12月在复旦大学附属中山医院就诊的53例临床疑似CAD患者,均进行超声心动图检查、有创冠状动脉造影和FFR测量.根据冠脉造影结果将患者分为心肌缺血组(FFR ≤0.8,24例)和非心肌缺血组(FFR＞0.8,29例).采用PSL进行脱机分析,获得左室整体做功指数(global work index,GWI)、整体有效功(global constructive work,GCW)、整体无效功(global wasted work,GWW)、整体做功效率(global work efficiency,GWE)、整体正向功(global positive work,GPW)及整体收缩期有效功(global systolic constructive work,GSCW)等心肌做功参数值,进行两组间比较.采用ROC曲线分析心肌做功参数对心肌缺血的诊断效能.结果 在18、16和12节段水平,与非心肌缺血组相比,心肌缺血组GWI、GCW、GPW、GSCW均降低(P＜0.001).ROC 曲线显示,GWI、GCW、GPW、GSCW 在 18 节段水平 AUC 分别为 0.803(95％CI 0.679～0.927)、0.807(95％CI 0.687～0.928)、0.822(95％CI 0.708～0.936)、0.819(95％CI 0.703～0.935).其中,GWI 最佳截断值为1 676.3 mmHg％,预测心肌缺血的灵敏度、特异度和准确度分别为70.8％、86.2％和79.2％;GCW最佳截断值为1 999.4 mmHg％,预测心肌缺血的灵敏度、特异度和准确度分别为75.0％、82.8％和79.2％.结论 采用PSL分析心肌做功对CAD心肌缺血人群有较好的筛查作用.
Value of non-invasive left ventricular myocardial work in the diagnosis of myocardial ischemia in coronary heart disease
Objective To evaluate the diagnostic value of myocardial work related parameters in coronary ischemia patients with coronary artery disease(CAD)coronary ischemia using non-invasive left ventricular pressure strain loop(PSL),taking fraction flow reservation(FFR)as the gold standard.Methods From December 2020 to December 2021,53 clinically suspected CAD patients were prospectively enrolled.All patients underwent echocardiography,invasive coronary angiography and FFR measurement.According to the results of coronary angiography,patients were divided into myocardial ischemia group(n=24,FFR≤0.80)and non-myocardial ischemia group(n=29,FFR＞0.80).PSL was used for off-line analysis to obtain the global work index(GWI),global constructive work(GCW),global wasted work(GWW),global work efficiency(GWE),global positive work(GPW),and global systolic constructive work(GSCW)and other myocardial work parameters.The differences of parameter values between the two groups were compared.The diagnostic efficacy of work parameters in myocardial ischemia was analyzed by ROC curve.Results Compared with the non-myocardial ischemia group,GWI,GCW,GPW and GSCW were significantly decreased in the myocardial ischemia group at the 18-,16-,and 12-segment levels(P＜0.001).The ROC curve showed that the AUC results of GWI,GCW,GPW,GSCW at the 18-segment level were 0.803(95％CI 0.679-0.927),0.807(95％CI 0.687-0.928),0.822(95％CI 0.708-0.936),0.819(95％CI 0.703-0.935).The optimal cut-off value of GWI was 1 676.3 mmHg％,and the sensitivity,specificity and accuracy of predicting myocardial ischemia were 70.8％,86.2％and 79.2％,respectively.The optimal cut-off value of GCW was 1 999.4 mmHg％,and the sensitivity,specificity and accuracy of predicting myocardial ischemia were 75.0％,82.8％and 79.2％,respectively.Conclusions Analyzing myocardial work using PSL has good significance for screening suspected myocardial ischemia in CAD patients.

echocardiographypressure strain loopfraction flow reservationcoronary artery diseasemyocardial ischemia

赵盈洁、何芙蓉、何玮、过伟锋、赵士海、葛振一、姚志锋、陈海燕、潘翠珍、舒先红

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上海市影像医学研究所,上海 200032

复旦大学附属中山医院心脏超声诊断科,上海 200032

复旦大学附属中山医院心内科,上海 200032

复旦大学基础医学院,上海 200032

复旦大学附属中山医院血管外科,上海 200032

复旦大学附属中山医院放射科,上海 200032

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超声心动图 压力应变环 血流储备分数 冠心病 心肌缺血

上海市自然科学基金上海市科学技术委员会项目上海市临床重点专科项目

22ZR1426000202140291shslczdzk03501

2024

10.12025/j.issn.1008-6358.2024.20231344

中国临床医学
复旦大学附属中山医院

中国临床医学

CSTPCD
影响因子：1.002
ISSN：1008-6358
年,卷(期)：2024.31(3)