Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China.
Department of Ultrasound, Binhai Campus of the First Affiliated Hospital, National Regional Medical Center, Fujian Medical University, Fuzhou, 350212, China.
Int J Cardiovasc Imaging. 2023 Aug;39(8):1505-1514. doi: 10.1007/s10554-023-02874-2. Epub 2023 May 31.
We investigated myocardial work in hypertension (HT) among patients with different left ventricular ejection fraction (LVEF) to analyze the contribution of segmental myocardial work to global myocardial work. 114 patients with HT were divided into 4 groups: HTsnEF ("supra-normal" EF, > 65%); HTnEF ("normal" EF, 60-65%); HTmEF (designed as "middle" EF, 50-60%, within an abnormal LV geometry); HTrEF (reduced EF, < 50%). Longitudinal strain (LS) and myocardial work indices were obtained by echocardiography: myocardial work index (MWI), constructive work (MCW), wasted work (MWW), myocardial work efficiency (MWE), and percentages of apical work were calculated (P, P). Global LS (GLS) and global MWE (GWE) decreased in HTmEF and HTrEF groups. Global MWI(GWI) and MCW(GCW) increased in HTsnEF and HTnEF groups, and subsequently decreased, particularly in HTrEF group (P < 0.05). GWW increased in all HT subgroups. All segmental MWI and MCW were elevated or preserved initially in HTsnEF and HTnEF groups, and subsequently decreased, obviously in basal and middle segments in HTrEF group (P < 0.05). All segmental MWW increased and MWE decreased in HTmEF and HTrEF groups (P < 0.05). P and P increased initially, and subsequently decreased in HTmEF group, and elevated significantly in HTrEF group. Correlation analysis revealed a close connection of GLS and myocardial work parameters with LVEF. Apical myocardial work increased at the early stages of hypertensive systolic dysfunction, as a compensatory mechanism. Segmental myocardial work analysis added value to explore the distribution of myocardial impairment.
我们研究了不同左心室射血分数（LVEF）的高血压（HT）患者的心肌做功，以分析节段心肌做功对整体心肌做功的贡献。将 114 例 HT 患者分为 4 组：HTsnEF（“超正常”EF，>65%）；HTnEF（“正常”EF，60-65%）；HTmEF（设计为“中间”EF，50-60%，左心室几何形状异常）；HTrEF（EF 降低，<50%）。通过超声心动图获得纵向应变（LS）和心肌做功指数：心肌做功指数（MWI）、构建功（MCW）、浪费功（MWW）、心肌做功效率（MWE）和心尖做功百分比（P、P）。HTmEF 和 HTrEF 组的 GLS 和 GWE 降低。HTsnEF 和 HTnEF 组的 GWI 和 GCW 增加，随后降低，尤其是 HTrEF 组（P<0.05）。所有 HT 亚组的 GWW 增加。HTsnEF 和 HTnEF 组的所有节段 MWI 和 MCW 最初升高或保持不变，随后降低，尤其是 HTrEF 组的基底段和中段（P<0.05）。HTmEF 和 HTrEF 组的所有节段 MWW 增加，MWE 降低（P<0.05）。HTmEF 组的 P 和 P 最初升高，随后降低，而 HTrEF 组明显升高。相关性分析显示，GLS 和心肌做功参数与 LVEF 密切相关。高血压收缩功能障碍的早期阶段，心尖心肌做功增加，作为一种代偿机制。节段性心肌做功分析增加了探讨心肌损伤分布的价值。
