不同左心室构型的高血压患者的节段性和整体心肌做功。
Segmental and global myocardial work in hypertensive patients with different left ventricular geometry.
机构信息
Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Fuzhou, 350005, China.
Department of Ultrasound, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
出版信息
Cardiovasc Ultrasound. 2023 Jun 27;21(1):11. doi: 10.1186/s12947-023-00310-y.
BACKGROUND
Myocardial work acquired by echocardiography has emerged as a novel method to evaluate myocardial function. We investigated global and segmental myocardial work in hypertension (HT) among patients with different patterns of left ventricular (LV) geometry in order to analyze the contribution of segmental myocardial work to global myocardial work.
METHODS AND RESULTS
One hundred twenty-five patients with HT were divided into 4 groups: normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH) and eccentric hypertrophy (EH). Longitudinal strain (LS) and the following indices were obtained by echocardiography: myocardial work index (MWI), myocardial constructive work (MCW), myocardial wasted work (MWW), and myocardial work efficiency (MWE). The global longitudinal strain (GLS) decreased gradually among the groups: NG, CR, CH and EH (P < 0.001). Global MWI (GWI) and global MCW (GCW) did not change across the different LV remodeling groups. Global MWW (GWW) increased and global MWE (GWE) decreased in both CH and EH group (P < 0.001). The LS of basal and middle regions reduced gradually in all HT subgroups, while apical LS decreased only in the CH and EH groups (P < 0.001). Basal MWI and MCW decreased in the CH and EH groups (P = 0.025, 0.007, respectively). Apical MWI and MCW increased in the NG and CR groups (P = 0.015, 0.044, respectively), with a decreasing trend in the CH and EH groups. All segmental MWW elevated and MWE reduced significantly in the CH and EH groups (P < 0.001). Univariate and multivariate logistic regression analyses demonstrated a significant association between left atrial volume index (LAVI), GLS, GWE and LV hypertrophy. At the receiver operating characteristic (ROC) analysis, optimal cutoff values of GLS, Apical LS, GWE and Apical MWE discriminating LV hypertrophy were 0.9072, 0.8049, 0.8325 and 0.7414, respectively.
CONCLUSION
Apical myocardial work increases in the early stages of LV remodeling, likely as a compensatory mechanism to maintain normal global myocardial work. Segmental myocardial work analysis offers a reliable means to explore the distribution of myocardial impairment in hypertensive patients at different LV remodeling stages.
背景
超声心动图获得的心肌做功已成为评估心肌功能的一种新方法。我们研究了不同左心室（LV）几何形状模式的高血压（HT）患者中的整体和节段心肌做功，以分析节段心肌做功对整体心肌做功的贡献。
方法和结果
将 125 例 HT 患者分为 4 组：正常几何组（NG）、同心重构组（CR）、同心肥厚组（CH）和偏心肥厚组（EH）。通过超声心动图获得纵向应变（LS）和以下指标：心肌做功指数（MWI）、心肌构建功（MCW）、心肌浪费功（MWW）和心肌做功效率（MWE）。各组的整体纵向应变（GLS）逐渐降低：NG、CR、CH 和 EH（P<0.001）。不同 LV 重构组之间的整体 MWI（GWI）和整体 MCW（GCW）没有变化。CH 和 EH 组的整体 MWW（GWW）增加，整体 MWE（GWE）降低（P<0.001）。所有 HT 亚组的基底和中部区域的 LS 逐渐降低，而 CH 和 EH 组的尖部 LS 降低（P<0.001）。CH 和 EH 组的基底 MWI 和 MCW 降低（P=0.025，0.007）。NG 和 CR 组的尖部 MWI 和 MCW 增加（P=0.015，0.044），而 CH 和 EH 组呈下降趋势。CH 和 EH 组的所有节段 MWW 显著升高，MWE 明显降低（P<0.001）。单因素和多因素逻辑回归分析表明，左心房容积指数（LAVI）、GLS、GWE 和 LV 肥厚之间存在显著相关性。在接受者操作特征（ROC）分析中，区分 LV 肥厚的 GLS、尖部 LS、GWE 和尖部 MWE 的最佳截断值分别为 0.9072、0.8049、0.8325 和 0.7414。
结论
LV 重构早期，心尖心肌做功增加，可能是维持整体心肌做功正常的代偿机制。节段心肌做功分析为研究不同 LV 重构阶段高血压患者心肌损害的分布提供了一种可靠的方法。
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