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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临床价值 |
赵盈洁1,2, 何芙蓉3,4, 何玮5, 过伟锋1,6, 葛振一1,2, 姚志锋3, 陈海燕2,1, 舒先红2,1, 潘翠珍2,1
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1.上海市影像医学研究所;2.复旦大学附属中山医院心超室;3.复旦大学附属中山医院心内科;4.复旦大学基础医学院;5.复旦大学附属中山医院血管外科;6.复旦大学附属中山医院放射科
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摘要: |
目的 旨在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)心肌缺血患者功能状态的诊断价值。 方法 前瞻性纳入45名临床疑似CAD患者,所有患者均进行超声心动图检查,有创冠状动脉造影和FFR测量,根据冠脉造影结果分为心肌缺血组(FFR ≤ 0.8)18例,非心肌缺血组(FFR > 0.8)27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)及整体做功效率(global work efficiency,GWE)等心肌做功参数,观察比较不同组间的参数差异以及分析有意义参数对于心肌缺血的诊断效能。 结果 不论是在18节段或是16和12节段水平,与非心肌缺血组相比,心肌缺血组的GWI、GCW、GPW、GSCW均明显降低(P<0.001)。18节段水平ROC曲线显示AUC结果分别为GWI:0.809(95% CI:0.675 ~ 0.942),GCW:0.782(95% CI:0.643 ~ 0.921),GPW:0.815(95% CI:0.688 ~ 0.941),GSCW:0.802(95% CI:0.671 ~ 0.934)。GWI最佳截断值为1676.3mmHg%,预测心肌缺血的灵敏度、特异度和准确度分别为72.2%、85.2%和80.0%。GCW最佳截断值为1929.3mmHg%,预测心肌缺血的灵敏度、特异度和准确度分别为61.1%、88.9%和77.8%。 结论 PSL结合后负荷和应变指标在CAD患者中有良好的诊断价值,对于可疑的心肌缺血人群的筛查有很好的临床意义。 |
关键词: 超声心动图描记术 心肌做功 冠状动脉血流储备分数 冠心病 |
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基金项目:上海市科学技术委员会(202140291);上海市自然科学(22ZR1426000);上海市临床重点专科项目经费资助(shslczdzk03501) |
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The clinical value of noninvasive left ventricular myocardial work in the diagnosis of myocardial ischemia in coronary heart disease: a comparative study with coronary flow reserve fraction |
Zhao Yingjie1,2, He Furong3,4, He Wei5, Guo Weifeng1,6, Ge Zhenyi1,2, Yao Zhifeng3, Chen Haiyan1,2, Shu Xianhong1,2, Pan Cuizhen1,2
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1.Shanghai Institute of Medical Imaging, Shanghai;2.Department of Echocardiography, Zhongshan Hospital, Shanghai;3.Department of Cardiology,Zhongshan Hospital, Shanghai;4.College of Basic Medical, Fudan University, Shanghai;5.Department of Vascular Surgery, Zhongshan Hospital, Shanghai;6.Department of Radiology, Zhongshan Hospital, Shanghai
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Abstract: |
Objective To evaluate the diagnostic value of myocardial work related parameters in patients with Coronary Artery Disease (CAD) coronary ischemia with non-invasive left ventricular pressure strain loop(PSL) using Fraction Flow Reservation (FFR) as the gold standard. Methods From September 2020 to September 2021, 45 clinically suspected CAD patients were prospectively enrolled. All patients underwent echocardiography, invasive coronary angiography and FFR measurement. According to the results of coronary angiography, 18 patients were divided into myocardial ischemia group (FFR ≤ 0.80) and non-myocardial ischemia group (FFR >0.80) 27 cases. PSL was used for off-line analysis to obtain the global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) and other myocardial work parameters. The differences of parameters between different groups were observed and compared, and the diagnostic efficacy of meaningful parameters for myocardial ischemia was analyzed. Results Compared with the non-myocardial ischemia group, GWI, GCW, GPW and GSCW were significantly decreased in the myocardial ischemia group at either the 18-segment level or the 16-and 12-segment level (P < 0.001). The ROC curve at the 18-segment level showed that the AUC results were GWI: 0.809 (95%CI: 0.675-0.942), GCW: 0.782 (95%CI: 0.643-0.921), GPW: 0.815 (95%CI: 0.643-0.921), respectively. 0.688-0.941), GSCW: 0.802 (95%CI: 0.671-0.934). The optimal cut-off value of GWI was 1676.3mmHg%, and the sensitivity, specificity and accuracy of predicting myocardial ischemia were 72.2%, 85.2% and 80.0%, respectively. The optimal cut-off value of GCW was 1929.3mmHg%, and the sensitivity, specificity and accuracy of predicting myocardial ischemia were 61.1%, 88.9% and 77.8%, respectively. Conclusions PSL combined with post-load and strain indexes has good diagnostic value in CAD patients, and has good clinical significance for screening suspected myocardial ischemia. |
Key words: Echocardiography Myocardial Work Fraction Flow Reservation Coronary Artery Disease |