收稿日期: 2024-04-25
网络出版日期: 2024-11-05
基金资助
广东省自然科学基金面上项目(2022A1515010353)
The value of noninvasive left ventricular pressure⁃strain loop in evaluating left ventricular function and left ventricular remodeling before and after percutaneous coronary artery intervention in patients with acute myocardial infarction
Received date: 2024-04-25
Online published: 2024-11-05
目的 探讨基于无创左室压力-应变环（LV-PSL）技术评估急性心肌梗死（AMI）患者经皮冠状动脉介入（PCI）术前、后的心肌做功情况及左室重构的临床价值。 方法 选择70例AMI患者（冠心病组）及同期体检的50例健康成人（对照组）。比较对照组和冠心病组术前、术后7 d检查常规超声心动图指标、左室整体纵向应变（GLS）和左室心肌做功指标［整体做功指数（GWI）、整体做功效率（GWE）、整体有用功（GCW）、整体无用功（GWW）］的差异。冠心病组患者进一步根据冠脉造影结果分为冠心病单支组34例和冠心病多支组36例，对比两组上述指标的差异。分析左室心肌做功指标与GLS、常规超声心动图指标的相关性。 结果 冠心病组术前、术后7 d左室收缩末期容积（LVESV）、左室舒张末期容积（LVEDV）、GWW均高于对照组，左室射血分数（LVEF）、GWI、GWE、GCW、GLS均低于对照组，差异均有统计学意义（P < 0.05）。冠心病组术后7 d LVESV、LVEDV、GWW均低于术前，LVEF、GWI、GWE、GCW、GLS均高于术前，差异均有统计学意义（P < 0.05）。冠心病多支组术前及术后7 d LVESV 、LVEDV、GWW均高于冠心病单支组，LVEF、GWI、GWE、GCW、GLS均低于冠心病单支组，差异均有统计学意义（P < 0.05）。相关性分析显示，GWW与GLS、LVEF均呈负相关，GWE、GCW、GWI与GLS、LVEF均呈正相关（P < 0.001）。 结论 LV-PSL技术在评估AMI患者PCI术前、后左心功能及左室重构方面具有较好的应用价值，为临床急性心肌梗死患者经皮冠状动脉介入术术后提供了一种无创、有效的评估新方法。
王歆赫 , 叶创文 , 童华生 , 孟菲 , 朱贤胜 . 无创左室压力-应变环评估急性心肌梗死患者经皮冠状动脉介入术前后左心功能及左室重构的价值[J]. 实用医学杂志, 2024 , 40(20) : 2841 -2847 . DOI: 10.3969/j.issn.1006-5725.2024.20.005
Objective To explore the clinical value of noninvasive left ventricular pressure-strain loop （LV-PSL） technique in evaluating myocardial work and left ventricular remodeling before and after percutaneous coronary intervention （PCI） in patients with acute myocardial infarction （AMI）. Methods Seventy patients with AMI admitted to our hospital （coronary heart disease group） and 50 healthy adults （control group） who underwent physical examination during the same period were selected， The conventional echocardiographic indexes， left ventricular global longitudinal strain （GLS） and left ventricular myocardial work indexes， ［global work index（GWI）， global work efficiency（GWE）， global constructive work（GCW）， global wasted work （GWW）］were examined before and 7 days after operation in control group and coronary heart disease group. The differences of the above indexes between the coronary heart disease group and control groups were compared. According to the results of coronary angiography， AMI patients were further divided into a coronary heart disease single-branch group （34 cases） and a coronary heart disease multi-branch group （36 cases）， and the differences of the above indexes between the two groups were compared. Analyze the correlation between left ventricular myocardial work indexes and GLS， conventional echocardiographic indexes. Result Left ventricular end-systolic volume （LVESV）， left ventricular end-diastolic volume （LVEDV） and GWW were higher incoronary heart disease group than in control group before and 7 days after surgery， while left ventricular ejection fraction （LVEF）， GWI， GWE， GCW and GLS were lower than control group， with statistical significance （all P < 0.05）. At 7 days after surgery， LVESV， LVEDV and GWW in the coronary heart disease group were lower than those before surgery， while LVEF， GWI， GWE， GCW and GLS were higher than those before surgery， with statistical significance （all P < 0.05）. LVESV， LVEDV and GWW at 7 days before and after surgery in the coronary heart disease multi-branch group were higher than those in the coronary heart disease single-branch group， while LVEF， GWI， GWE， GCW and GLS were lower than those in the coronary heart disease single-branch group， with statistical significance （all P < 0.05）. Correlation analysis showed that GWW was negatively correlated with GLS and LVEF， while GWE， GCW and GWI were positively correlated with GLS and LVEF （all P < 0.001）. Conclusion LV-PSL technique has good application value in evaluating left ventricular function and left ventricular remodeling in AMI patients before and after PCI， and provides a new non-invasive method for clinical practice.
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