全球心肌做功优于整体纵向应变，可预测左心室功能和壁运动正常的患者中有意义的冠状动脉疾病。

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.

机构信息

Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia; School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.

Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia.

出版信息

J Am Soc Echocardiogr. 2019 Aug;32(8):947-957. doi: 10.1016/j.echo.2019.02.014. Epub 2019 Apr 28.

DOI:10.1016/j.echo.2019.02.014

PMID:31043359

Abstract

BACKGROUND

Noninvasive detection of functionally significant coronary artery disease (CAD) by echocardiography remains challenging, with the need to perform stress imaging to detect ischemia. The aim of this study was to determine whether global myocardial work (MW), derived from noninvasive left ventricular (LV) pressure-strain loops at rest, can predict significant CAD in patients without regional wall motion abnormalities and preserved LV ejection fraction (EF).

METHODS

One hundred and fifteen patients referred for coronary angiography who had EF ≥ 55%, no resting regional wall motion abnormalities, and no chest pain were assessed using echocardiography. Global MW was derived from noninvasive LV pressure-strain loops constructed from speckle-tracking echocardiography indexed to brachial systolic blood pressure. Global constructive work represented the sum of positive work due to myocardial shortening during systole and negative work due to lengthening during isovolumic relaxation. Global wasted work represented energy loss by myocardial lengthening in systole and shortening in isovolumic relaxation. Global MW efficiency was derived from the percentage ratio of constructive work to the sum of constructive work and wasted work.

RESULTS

Patients with significant CAD demonstrated a significantly reduced global MW (P < .001) compared with those without CAD. Global longitudinal strain was significantly reduced (P < .001) in patients with multivessel CAD but not those with single-vessel CAD (P = .47). Receiver operating characteristic curve analysis demonstrated that global MW was the most powerful predictor of significant CAD (area under the curve = 0.786) and was superior to global longitudinal strain (area under the curve = 0.693). The optimal cutoff global MW value to predict significant CAD was 1,810 mm Hg% (sensitivity, 92%; specificity, 51%).

CONCLUSIONS

Noninvasive global MW derived using LV pressure-strain loops at rest is a more sensitive index than global longitudinal strain to detect significant CAD in patients with no regional wall motion abnormalities and normal EF. This is a potential valuable clinical tool to assist in the early diagnosis of CAD.

摘要

背景

通过超声心动图对功能性显著冠状动脉疾病（CAD）进行非侵入性检测仍然具有挑战性，需要进行应激成像以检测缺血。本研究旨在确定静息状态下从非侵入性左心室（LV）压力-应变环获得的整体心肌做功（MW）是否可以预测无局部壁运动异常和保留左心室射血分数（EF）的患者中的显著 CAD。

方法

对 115 例因 EF≥55%、无静息局部壁运动异常且无胸痛而接受冠状动脉造影的患者进行了超声心动图评估。从斑点追踪超声心动图构建的 LV 压力-应变环中推导出整体 MW，并将其指数化到肱动脉收缩压。整体构建性工作代表由于心肌在收缩期间缩短而产生的正功和由于等容松弛期间延长而产生的负功之和。整体浪费工作代表心肌在收缩期间延长和等容松弛期间缩短所导致的能量损失。整体 MW 效率由构建性工作与构建性工作和浪费工作之和的百分比比值得出。

结果

与 CAD 患者相比，有显著 CAD 的患者的整体 MW 显著降低（P<0.001）。多支 CAD 患者的整体纵向应变明显降低（P<0.001），而单支 CAD 患者则没有（P=0.47）。接受者操作特征曲线分析表明，整体 MW 是显著 CAD 的最强预测指标（曲线下面积为 0.786），优于整体纵向应变（曲线下面积为 0.693）。预测显著 CAD 的最佳截断值为 1810mm Hg%（敏感性为 92%，特异性为 51%）。