超声左心室压力-应变环定量参数与肥厚型心肌病继发心力衰竭的相关性及预警价值

doi:10.3969/j.issn.1006-6233.2025.10.027

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摘要 目的: 探讨超声左心室压力-应变环(PSL)定量参数与肥厚型心肌病(HCM)继发心力衰竭(HF)的相关性及预警价值。方法: 选取2021年1月至2023年6月临汾市人民医院HCM患者216例进行前瞻性研究,入院时均行超声PSL检查,随访1年,根据是否继发HF分为HF组与非HF组,比较两组基线资料、超声PSL定量参数[胸骨旁短轴切面的左心室整体圆周应变(LVGCS)、心内膜下心肌(CS-Endo)、中层心肌(CS-Mid)、心外膜下心肌(CS-Epi)、左心室整体扭转应变(Twist)、左心室整体纵向应变(LVGLS)、左心室整体径向应变(LVGRS),心尖切面的心内膜下心肌(LS-Endo)、中层心肌(LS-Mid)、心外膜下心肌(LS-Epi)、纵向应变及峰值应变离散度(PSD)、心肌整体无用功(GWW)、整体有用功(GCW)、整体做功指数(GWI)、整体做功效率(GWE)],分析超声PSL定量参数与HCM继发HF的相关性及预警价值。结果: 随访1年,失访3例,发生HF 31例,未发生HF 182例,分别纳入HF组与非HF组。HF组年龄大于非HF组,HCM病程长于非HF组,入院时室间隔厚度高于非HF组,LVEF低于非HF组(P<0.05);HF组GWW高于非HF组,GCW、GWI、GWE低于非HF组(P<0.05);Pearson相关性分析,GWW与室间隔厚度呈正相关,与LVEF呈负相关,GCW、GWI、GWE与室间隔厚度呈负相关,与LVEF呈正相关(P<0.05);偏相关性分析,GWW、GCW、GWI、GWE与HCM继发HF显著相关(P<0.05);ROC曲线分析,GWW、GCW、GWI、GWE预警HCM继发HF的AUC为0.786、0.775、0.721、0.795,敏感度为77.42%、83.87%、64.52%、74.19%,特异度为69.23%、64.84%、76.92%、73.63%;GWW、GCW、GWI、GWE联合预警的AUC为0.913,敏感度为87.10%,特异度为78.02%,显著优于单独预警价值(Z=2.540、2.671、3.058、2.252,P=0.011、0.008、0.002、0.024)。结论: 超声PSL定量参数GWW、GCW、GWI、GWE与HCM继发HF显著相关,可作为有效预警指标,且联合预警价值更可靠。

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关键词 ：肥厚型心肌病, 心力衰竭, 超声, 左心室压力-应变环

Abstract：Objective: To investigate the correlation and early warning value of quantitative parameters of ultrasonic left ventricular pressure-strain loop (PSL) with heart failure (HF) secondary to hypertrophic cardiomyopathy (HCM). Methods: A prospective study was conducted on 216 HCM patients in Linfen People's Hospital from January 2021 to June 2023. All patients underwent ultrasound PSL examination upon admission. The patients were followed up for 1 year and were divided into HF group and non-HF group according to whether they had secondary HF. Baseline data and quantitative parameters of ultrasound PSL were compared between the two groups, including left ventricular global circumferential strain (LVGCS) in parasternal short axis view, subendocardial myocardial (CS-Endo), midmyocardial (CS-Mid), subepicardial myocardial (CS-Epi), left ventricular global torsional strain (Twist), left ventricular global longitudinal strain (LVGLS), left ventricular global radial strain (LVGRS), subendocardial myocardial (LS-Endo), midmyocardial (LS-Mid), subepicardial myocardial (LS-Epi), longitudinal strain and peak strain dispersion (PSD), global work of no use (GWW), global work of use (GCW), global work index (GWI), and global work efficiency (GWE) in apical view. The correlation and early warning value of ultrasound PSL quantitative parameters with HF secondary to HCM were analyzed. Results: After a 1-year follow-up, three patients were lost to follow-up, 31 patients developed HF, and 182 patients did not develop HF. The HF group was older than the non-HF group, had a longer duration of HCM than the non-HF group, had a higher interventricular septal thickness at admission than the non-HF group, and had a lower LVEF than the non-HF group (P<0.05). The HF group had a higher GWW than the non-HF group, and a lower GCW, GWI, and GWE than the non-HF group (P<0.05). Pearson correlation analysis showed that GWW was positively correlated with interventricular septum thickness and negatively correlated with LVEF, while GCW, GWI, and GWE were negatively correlated with interventricular septum thickness and positively correlated with LVEF (P<0.05). In the partial correlation analysis, GWW, GCW, GWI, and GWE were significantly correlated with HCM-induced HF (P<0.05). ROC curve analysis showed that the AUC of GWW, GCW, GWI, and GWE for predicting HF secondary to HCM was 0.786, 0.775, 0.721, and 0.795, with sensitivities of 77.42%, 83.87%, 64.52%, and 74.19%, and specificities of 69.23%, 64.84%, 76.92%, and 73.63%. The AUC of the combined warning of GWW, GCW, GWI, and GWE was 0.913, with a sensitivity of 87.10% and a specificity of 78.02%, which was significantly better than the value of individual warning (Z=2.540, 2.671, 3.058, 2.252, P=0.011, 0.008, 0.002, 0.024). Conclusions: The quantitative parameters of ultrasound PSL, GWW, GCW, GWI, and GWE, are significantly correlated with HF secondary to HCM, and can be used as effective early warning indicators, and the combined early warning value is more reliable.

Key words： Hypertrophic cardiomyopathy Heart failure Ultrasound Left ventricular pressure-strain loop

引用本文:

吴金巧, 陈晓燕, 郭丽焱, 张拾命, 张喜贝. 超声左心室压力-应变环定量参数与肥厚型心肌病继发心力衰竭的相关性及预警价值[J]. 河北医学, 2025, 31(10): 1737-1743.
WU Jinqiao, GUO Liyan, ZHANG Shiming, et al. The Correlation and Early Warning Value of Quantitative Parameters of Ultrasonic Left Ventricular Pressure-Strain Loop with Heart Failure Secondary to Hypertrophic Cardiomyopathy. HeBei Med, 2025, 31(10): 1737-1743.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2025.10.027 或 http://www.hbyxzzs.cn/CN/Y2025/V31/I10/1737

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