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赵盈洁，何芙蓉，何　玮，等. 无创左室压力应变曲线在冠心病心肌缺血诊断中的价值[J]. 中国临床医学, 2024, 31(3): 411-419. DOI: 10.12025/j.issn.1008-6358.2024.20231344
引用本文: 赵盈洁，何芙蓉，何　玮，等. 无创左室压力应变曲线在冠心病心肌缺血诊断中的价值[J]. 中国临床医学, 2024, 31(3): 411-419. DOI: 10.12025/j.issn.1008-6358.2024.20231344
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ZHAO Y J, HE F R, HE W, et al. Value of non-invasive left ventricular myocardial work in the diagnosis of myocardial ischemia in coronary heart disease[J]. Chin J Clin Med, 2024, 31(3): 411-419. DOI: 10.12025/j.issn.1008-6358.2024.20231344
Citation: ZHAO Y J, HE F R, HE W, et al. Value of non-invasive left ventricular myocardial work in the diagnosis of myocardial ischemia in coronary heart disease[J]. Chin J Clin Med, 2024, 31(3): 411-419. DOI: 10.12025/j.issn.1008-6358.2024.20231344
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无创左室压力应变曲线在冠心病心肌缺血诊断中的价值

Value of non-invasive left ventricular myocardial work in the diagnosis of myocardial ischemia in coronary heart disease

    摘要
  • 摘要:
    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。

     

    Abstract:
    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.

     

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