| 摘要: |
| 目的：探讨应用二维斑点追踪技术及腺苷负荷状态下的经胸冠脉血流显像技术评价非冠脉梗阻性缺血性女性冠脉微血管功能障碍（CMD）与静息及负荷状态下左室收缩功能的关系。
方法：入选对疑似有心绞痛症状且近3个月行冠脉造影结果冠脉狭窄小于50%的女性患者行腺苷负荷状态下的经胸冠脉血流显像（TTDE）检查。根据TTDE测的冠脉血流速度储备（CFVR），分为CFVR＜2.0作为病例组26例，CFVR＞2.5作为对照组33例。在静息状态下及腺苷负荷状态下行常规超声心动图及二维斑点追踪成像检查。负荷状态下左室整体长轴应变(GLS)与静息状态下GLS差值即为左室整体长轴收缩储备(ΔGLS)。比较两组患者静息状态下常规超声心动图参数及ΔGLS有无差异。
结果：病例组在年龄、药物负荷状态时收缩压和舒张压、静息心率、糖尿病比例、高血压比例、高脂血症比例均高于对照组，差异均有统计学意义（P＜0.05，表2）；病例组药物负荷时GLS、ΔGLS低于对照组，差异有统计学意义（P＜0.05，表2）。相关性分析发现CMD患者CFVR与静息心率（r=-0.378）、负荷时GLS（r=0.320）、ΔGLS相关（r=0.615）（P＜0.05，表3）。经多元线性回归分析调整年龄、糖尿病、高血压、高脂血症、充血状态时收缩压和舒张压、静息心率、充血状态下GLS影响因素后，CFVR与ΔGLS仍独立相关（P＜0.05，β=0.906，表3）。
结论：非冠脉梗阻性缺血性心脏病的女性CMD与ΔGLS相关,CFVR越低，LV收缩储备功能越低；斑点追踪技术结合经胸冠脉血流显像技术可以早期评价冠状动脉非梗阻性缺血性心脏病的女性CMD的左室收缩储备功能。 |
| 关键词: 冠脉血流储备，冠状动脉微循环障碍，左心室功能，整体纵向应变 |
| DOI： |
| 投稿时间：2020-09-01修订日期：2021-06-08 |
| 基金项目:辽宁省科学技术计划项目 |
|
| Correlation of left ventricular systolic function with coronary microvascular dysfunction in female patients with Non-obstructive Coronary Artery Disease |
| zhuyanyan,ding ming yan,ji wei,zhang huihui,li ying,guo lijuan,liu ting ting,zhu fang |
| () |
| Abstract: |
| [Abstract]
0bjective : To investigate the relationship between coronary microvascular dysfunction (CMD) and left ventricular systolic function under rest and stress in female patients with non-coronary artery obstruction and ischemic heart disease by two-dimensional speckle tracking technique and transthoracic coronary flow imaging under adenosine stress.
Methods: Selected female patients with suspected symptoms of angina pectoris and coronary artery stenosis less than 50% in the past 3 months were examined by transthoracic coronary flow imaging (TTDE) under adenosine load. According to the coronary flow velocity reserve (CFVR) measured by TTDE, the selected people were divided into two groups: CFVR < 2.0 group (n = 26) and control group (n = 33). Routine echocardiography and two-dimensional speckle tracking imaging were performed at rest and adenosine load.The difference between the left ventricular global longitudinal strain (GLS) under load and the GLS at rest is the global left ventricular systolic reserve (ΔGLS). The parameters of routine echocardiography and Δ GLS in resting state were compared between the two groups.
Results:The age, systolic and diastolic blood pressure under adenosine stress, resting heart rate, proportion of diabetes, hypertension and hyperlipidemia in the case group were significantly higher than those in the control group (P＞0.05, Table 2). The GLS andΔGLS under adenosine stress in the case group were significantly lower than those in the control group (P< 0.05, Table 2). Correlation analysis showed that CFVR was correlated with resting heart rate（r=-0.378）, GLS （r=0.320）and ΔGLS（r=0.615） under hyperemia (P< 0.05, Table 3). After adjusting the influencing factors of age, diabetes, hypertension, hyperlipidemia, systolic and diastolic blood pressure, resting heart rate and GLS during hyperemia by multiple linear regression analysis, CFVR andΔGLS were still independently correlated (P<0.05,β=0.906,Table 3).
Conclusion: CMD is associated with GLS reserve in female patients with non-obstructive ischemic heart disease, and the lower the CFVR, the worse the systolic reserve function of LV. Speckle tracking combined with transthoracic coronary flow imaging can early evaluate the left ventricular systolic reserve function of CMD in female patients with non-obstructive ischemic heart disease. |
| Key words: coronary flow reserve, coronary microvascular , left ventricular systolic function,Global Longitudinal Strain |
