应用无创左心室压力-应变环测量技术分析妊娠期糖尿病患者的心肌做功。

Quantitative Analysis of Myocardial Work in Gestational Diabetes Mellitus Using Noninvasive Left Ventricular Pressure-Strain Loop Measurement.

机构信息

Department of Medical Ultrasonics, First Affiliated Hospital of Guangxi Medical University, Nanning, China.

Hubei Provinical Clinical Research Center for Accurate Fetus Malformation Diagnosis, Department of Ultrasound, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China.

出版信息

Echocardiography. 2024 Oct;41(10):e15944. doi: 10.1111/echo.15944.

DOI:10.1111/echo.15944

PMID:39387115

Abstract

BACKGROUND

Gestational diabetes mellitus (GDM) poses a risk for cardiovascular damage during pregnancy. This study focused on evaluating changes in left ventricular myocardial performance in GDM patients using the left ventricular pressure-strain loop (LV-PSL) method and examining risk factors associated with reduced myocardial function.

METHODS

A prospective, randomized study involving 112 pregnant women diagnosed with GDM was conducted from June 2021 to June 2024. Additionally, 84 healthy pregnant women from the same period served as the control group. Utilizing both conventional echocardiography and two-dimensional speckle tracking echocardiography, left ventricular myocardial work metrics were assessed using LV-PSL technology.

RESULTS

GDM patients demonstrated significantly reduced values for global longitudinal strain (GLS), global work index (GWI), global work efficiency (GWE), and global constructive work (GCW) (p < 0.05), while conventional ultrasound measures showed no significant difference between GDM and control groups. GWI, GWE, GCW, and GLS had high predictive value for cardiac function changes in GDM patients, with GWE showing the highest predictive value {Area under curve (AUC) = 0.866, cutoff value = 95.5%, specificity = 0.77, sensitivity = 0.87}. GWI, GWE, and GCW were negatively correlated with GLS (r = -0.532, -0.411, -0.425, all p < 0.001), whereas global wasted work (GWW) showed a positive correlation with GLS (r = 0.325 and p < 0.001). These parameters were also correlated with HbA1c levels (r = -0.316, -0.256, -0.260, all p < 0.001 for negative correlations, and r = 0.172, p < 0.05 for positive correlations). Multivariate logistic regression indicated that 1-h OGTT (mmol/L), 2-h OGTT (mmol/L), and HbA1c (%) were significant predictors of left ventricular systolic function (GWE) in GDM patients.

CONCLUSIONS

LV-PSL is an effective tool for early detection of left ventricular systolic function impairment in GDM patients.

摘要

背景

妊娠糖尿病（GDM）会增加孕妇心血管损伤的风险。本研究旨在使用左心室压力-应变环（LV-PSL）方法评估 GDM 患者左心室心肌性能的变化，并探讨与心肌功能降低相关的危险因素。

方法

本研究为前瞻性、随机研究，纳入 2021 年 6 月至 2024 年 6 月期间诊断为 GDM 的 112 例孕妇，并设同期 84 例健康孕妇为对照组。采用常规超声心动图和二维斑点追踪超声心动图，利用 LV-PSL 技术评估左心室心肌工作指标。

结果

GDM 患者的整体纵向应变（GLS）、整体做功指数（GWI）、整体做功效率（GWE）和整体构建功（GCW）均显著降低（p<0.05），而常规超声心动图指标在 GDM 组和对照组之间无显著差异。GWI、GWE、GCW 和 GLS 对 GDM 患者的心脏功能变化具有较高的预测价值，其中 GWE 的预测价值最高（AUC=0.866，截断值=95.5%，特异性=0.77，敏感性=0.87）。GWI、GWE 和 GCW 与 GLS 呈负相关（r=-0.532、-0.411、-0.425，均 p<0.001），而整体浪费功（GWW）与 GLS 呈正相关（r=0.325，p<0.001）。这些参数与 HbA1c 水平也呈负相关（r=-0.316、-0.256、-0.260，均 p<0.001，正相关 r=0.172，p<0.05）。多变量逻辑回归分析表明，1 h OGTT（mmol/L）、2 h OGTT（mmol/L）和 HbA1c（%）是 GDM 患者左心室收缩功能（GWE）的显著预测因子。