Department of Ultrasound, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
Department of Ultrasound, Nanchang First Hospital, Nanchang, China.
Echocardiography. 2024 Mar;41(3):e15801. doi: 10.1111/echo.15801.
This study aimed to analyze myocardial work in patients with atrial fibrillation (AF) using a noninvasive pressure strain loop (PSL) technique to provide a basis for the quantitative assessment of left ventricular (LV) systolic function.
LV myocardial work of 107 AF patients (56 with paroxysmal atrial fibrillation and 51 with persistent atrial fibrillation) and 55 healthy individuals were assessed by the noninvasive PSL and then compared.
Global longitudinal strain (GLS) in absolute values, global work index (GWI), global constructive work (GCW), and global work efficiency (GWE) were significantly lower in the AF group than control group, whereas peak strain dispersion (PSD) and global wasted work (GWW) were significantly higher (P < .05). Further subdivision according to the AF type revealed that, compared with the controls, GLS in absolute values and GWE decreased significantly; PSD and GWW increased significantly in the paroxysmal AF group (P < .05). Nevertheless, GWI and GCW were not significantly different between paroxysmal AF and control groups (P > .05). Compared to paroxysmal AF, persistent AF induced a further decrease in absolute GLS and GWE and a further increase in GWW (P < .05), but PSD did not increase further (P > .05). Multiple linear regression analysis showed that GWI and GCW were independently associated with systolic blood pressure. GWW was associated with types of AF and left atrial volume index (LAVI). GWE was correlated with age, types of AF, disease duration, and LAVI. Receiver operating characteristic curve analysis showed that the area under the curve predicting myocardial injury was higher for GWE and GWW than for GLS (area under the curve: .880, .846, and .821, respectively).
Non-invasive PSL can quantitatively assess LV systolic function in patients with different kinds of AF and detect early subclinical myocardial injury in patients with paroxysmal AF. GWE and GWW outperform GLS and LV ejection fraction when assessing myocardial injury. Systolic blood pressure, type of AF, LVAI, disease duration, and age may be associated with myocardial injury in patients with AF.
本研究旨在使用非侵入性压力-应变环（PSL）技术分析心房颤动（AF）患者的心肌做功，为定量评估左心室（LV）收缩功能提供依据。
采用非侵入性 PSL 评估 107 例 AF 患者（阵发性 AF56 例，持续性 AF51 例）和 55 例健康个体的 LV 心肌做功，并进行比较。
与对照组相比，AF 组的整体纵向应变绝对值（GLS）、整体做功指数（GWI）、整体构建功（GCW）和整体做功效率（GWE）明显降低，而峰值应变离散度（PSD）和整体浪费功（GWW）明显升高（P<0.05）。根据 AF 类型进一步细分显示，与对照组相比，阵发性 AF 患者的 GLS 绝对值和 GWE 明显降低，PSD 和 GWW 明显升高（P<0.05）。然而，阵发性 AF 组和对照组的 GWI 和 GCW 无明显差异（P>0.05）。与阵发性 AF 相比，持续性 AF 进一步降低了 GLS 和 GWE 的绝对值，并进一步增加了 GWW（P<0.05），但 PSD 没有进一步增加（P>0.05）。多元线性回归分析显示，GWI 和 GCW 与收缩压独立相关，GWW 与 AF 类型和左心房容积指数（LAVI）相关，GWE 与年龄、AF 类型、病程和 LAVI 相关。ROC 曲线分析显示，GWE 和 GWW 预测心肌损伤的曲线下面积高于 GLS（曲线下面积：分别为 0.880、0.846 和 0.821）。
非侵入性 PSL 可定量评估不同类型 AF 患者的 LV 收缩功能，并检测阵发性 AF 患者的早期亚临床心肌损伤。GWE 和 GWW 在评估心肌损伤方面优于 GLS 和 LV 射血分数。收缩压、AF 类型、LVAI、病程和年龄可能与 AF 患者的心肌损伤有关。
