心肌做功技术在妊娠合并慢性高血压患者左心室收缩功能中的评价作用-东南大学学报医学版

心肌做功技术在妊娠合并慢性高血压患者左心室收缩功能中的评价作用

单位：1. 东南大学附属中大医院心内科, 江苏南京 210009;
2. 东南大学附属中大医院产科, 江苏南京 210009

分类号：R714.246

出版年·卷·期（页码）：2022·41·第三期（415-421）

摘要：

目的：应用心肌做功技术对妊娠合并慢性高血压患者的左心室收缩功能进行定量评价。方法：选取40例妊娠合并慢性高血压患者为病例组，选取同期40例正常妊娠者为对照组。自动功能成像（AFI）模式下获得左心室心肌整体纵向应变（GLS）、心肌整体做功指数（GWI）、整体无用功（GWW）、整体有用功（GCW）及整体做功效率（GWE）。采用独立样本t检验比较两组间差异，运用受试者工作特征（ROC）曲线分析心肌做功参数评价效能，采用组内相关系数（ICC）进行同一检查者和不同检查者间测量心肌做功参数的一致性检验。结果：与对照组相比，病例组GWI、GWW和GCW明显增高，GLS和GWE明显降低，差异均有统计学意义（P<0.05）。ROC曲线分析显示，在评价左心室收缩功能的指标中GLS和心肌做功参数诊断敏感度与特异度明显优于左心室射血分数（LVEF），其中GWW和GWE最佳。ICC分析显示同一检查者和不同检查者间获得的心肌做功参数具有良好的一致性。结论：心肌做功技术是一种无创、定量、敏感评价妊娠合并慢性高血压患者左心室收缩功能的有效方法。

Objective: To quantitatively assess the left ventricular systolic function in pregnant women with chronic hypertension by myocardial work. Methods: Forty pregnant women with chronic hypertension were selected as case group and 40 healthy pregnant women were selected as control group at the same period. Tracing analysis by automatic functional imaging(AFI) was conducted to obtain left ventricular global longitudinal strain(GLS), global work index(GWI), global wasted work(GWW), global constructive work(GCW) and global work efficiency(GWE). The differences between the two groups were compared by independent-samples t test. Receiver operating characteristic(ROC) curves were used to evaluate the efficacy of myocardial work indices. Intraclass correlation coefficients were used to analyze the correlation between myocardial work indices obtained by the same echocardiographer and the different echocardiographers. Results: Compared with the control group, the values of GWI, GWW and GCW were higher in case group(P<0.05). The values of GLS and GWE were lower in case group(P<0.05). The ROC curves showed that myocardial work indices and GLS were superior than left ventricular ejection fraction(LVEF), GWW and GWE were the best of all the parameters in the assessment of left ventricular systolic function in pregnant women with chronic hypertension. ICC results showed that the values of myocardial work indices obtained by the same echocardiographer and the different echocardiographers were consistent. Conclusion: Myocardial work is a non-invasive, quantitative and sensitive method to assess the left ventricular systolic function in pregnant women with chronic hypertension.

参考文献：

[1] BATEMAN B T, BANSIL P, HERNANDEZ-DIAZ S, et al. Prevalence, trends, and outcomes of chronic hypertension:a nationwide sample of delivery admissions[J].Am J Obstet Gynecol, 2012,206(2):134.e1-8.
[2] VASAPOLLO B, NOVELLI G P, GAGLIARDI G, et al. Pregnancy complications in chronic hypertensive patients are linked to pre-pregnancy maternal cardiac function and structure[J].Am J Obstet Gynecol, 2020,223(3):425.e1-13.
[3] KIM M J, SEO J, CHO K I, et al. Echocardiographic assessment of structural and hemodynamic changes in hypertension-related pregnancy[J].J Cardiovasc Ultrasound, 2016,24(1):28-34.
[4] MARCOLAN QUITETE C M, MARCOLAN SALVANY A, DE ANDRADE MARTINS W, et al. Left ventricular remodeling and diastolic function in chronic hypertensive pregnant women[J].Pregnancy Hypertens, 2015,5(2):187-192.
[5] DE HAAS S, GHOSSEIN-DOHA C, GEERTS L, et al. Cardiac remodeling in normotensive pregnancy and in pregnancy complicated by hypertension:systematic review and meta-analysis[J].Ultrasound Obstet Gynecol, 2017,50(6):683-696.
[6] RUSSELL K, ERIKSEN M, AABERGE L, et al. A novel clinical method for quantification of regional left ventricular pressure-strain loop area:a noninvasive index of myocardial work[J].Eur Heart J, 2012,33(6):724-733.
[7] HUBERT A, LE ROLLE V, LECLERCQ C, et al. Estimation of myocardial work from pressure-strain loops analysis:an experimental evaluation[J].Eur Heart J Cardiovasc Imaging, 2018,19(12):1372-1379.
[8] VAN DER BIJL P, KOSTYUKEVICH M, EL MAHDIUI M, et al. A roadmap to assess myocardial work:from theory to clinical practice[J].JACC Cardiovasc Imaging, 2019,12(12):2549-2554.
[9] MANGANARO R, MARCHETTA S, DULGHERU R, et al. Correlation between non-invasive myocardial work indices and main parameters of systolic and diastolic function:results from the EACVI NORRE study[J].Eur Heart J Cardiovasc Imaging, 2020, 21(5):533-541.
[10] 中华医学会妇产科学分会妊娠期高血压疾病学组. 妊娠期高血压疾病诊治指南(2020)[J].中华妇产科杂志, 2020,55(4):227-238.
[11] LANG R M, BADANO L P, MOR-AVI V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults:an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging[J].Eur Heart J Cardiovasc Imaging, 2015,16(3):233-270.
[12] MITCHELL C, RAHKO P S, BLAUWET L A, et al. Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults:recommendations from the American Society of Echocardiography[J].J Am Soc Echocardiogr, 2019,32(1):1-64.
[13] KONSTAM M A, ABBOUD F M. Ejection fraction:misunderstood and overrated(changing the paradigm in categorizing heart failure)[J].Circulation, 2017,135(8):717-719.
[14] YINGCHONCHAROEN T, AGARWAL S, POPOVIC Z B, et al. Normal ranges of left ventricular strain:a meta-analysis[J].J Am Soc Echocardiogr, 2013,26(2):185-191.
[15] BOE E, RUSSELL K, EEK C, et al. Non-invasive myocardial work index identifies acute coronary occlusion in patients with non-ST-segment elevation-acute coronary syndrome[J].Eur Heart J Cardiovasc Imaging, 2015,16(11):1247-1255.
[16] GALLI E, LECLERCQ C, HUBERT A, et al. Role of myocardial constructive work in the identification of responders to CRT[J].Eur Heart J Cardiovasc Imaging, 2018,19(9):1010-1018.
[17] CHAN J, EDWARDS N F A, KHANDHERIA B K, et al. A new approach to assess myocardial work by non-invasive left ventricular pressure-strain relations in hypertension and dilated cardiomyopathy[J].Eur Heart J Cardiovasc Imaging, 2019,20(1):31-39.
[18] SAHITI F, MORBACH C, HENNEGES C, et al. Dynamics of left ventricular myocardial work in patients hospitalized for acute heart failure[J].J Card Fail, 2021,27(12):1393-1403.
[19] HIEMSTRA Y L, VAN DER BIJL P, EL MAHDIUI M, et al. Myocardial work in nonobstructive hypertrophic cardiomyopathy:implications for outcome[J].J Am Soc Echocardiogr, 2020, 33(10):1201-1208.
[20] 丁雪晏, 李一丹, 魏丽群,等.左心室压力-应变环评价心脏淀粉样变性患者心肌做功[J].中华超声影像学杂志, 2021,30(7):604-608.
[21] SUN J P, XU T, YANG Y, et al. Layer-specific quantification of myocardial deformation may disclose the subclinical systolic dysfunction and the mechanism of preserved ejection fraction in patients with hypertension[J].Int J Cardiol, 2016,219:172-176.
[22] CONG J, LEE Y, FU X, et al. Quantitative evaluation of longitudinal strain in layer-specific myocardium in patients with preeclampsia[J].Int J Cardiovasc Imaging, 2018, 34(2):193-200.
[23] EDWARDS N F A, SCALIA G M, SHIINO K, et al. Global myocardial work is superior to Global Longitudinal Strain to predict significant coronary artery disease in patients with normal left ventricular function and wall motion[J].J Am Soc Echocardiogr, 2019,32(8):947-957.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录