| 摘要: |
| 目的 探讨射血分数保留性心衰(HFpEF)患者心肌舒张功能、心肌收缩力和动脉僵硬度间的关系。方法 选择HFpEF患者29例,年龄性别匹配的对照组受试者53例。分别获取动脉僵硬度指标动脉波速指数(AVI)、左心室结构参数室间隔厚度(IVSD)和左心室后壁厚度(LVPWD)、左心室舒张功能指标E/A和E/e’；心肌纵向收缩力指标左心室纵向应变(GLS)、心肌环向收缩力指标左心室环向应变(GCS)和整体收缩力指标左室射血分数(LVEF)。2组间比较采用独立样本t检验,相关分析采用Pearson相关分析和Logistic回归分析。结果 ①HFpEF组受试者动脉僵硬度指数AVI大于对照组(P均＜0.05)。②与对照组比较,HFpEF受试者IVSD和LVPWD增厚(P均＜0.01)；E/A减小而E/e’增大(P均＜0.01)；纵向收缩力GLS减低(P＜0.01),而环向收缩力GCS和整体收缩力差异无统计学意义(P均＞0.01)。③单因素相关分析发现,动脉僵硬度指标AVI与GCS呈负相关(r=-0.241,P＜0.05),而与E/e’成正相关(r=0.288,P＜0.05)；Logistic回归分析提示,AVI和LVPWD是发生HFpEF的危险因素,OR(95%CI)分别为1.240(1.045,1.471)和2.448(1.149,5.216)。结论 HFpEF患者动脉僵硬度增大、心室壁增厚、心肌的纵向收缩力减低,而心肌环向和整体收缩力正常。这种变化与动脉僵硬度增大和心室重构独立相关。 |
| 关键词: 超声心动图 HFpEF 动脉波速指数 环向应变 纵向应变 二维斑点追踪技术 |
| DOI： |
| 投稿时间：2022-11-13修订日期：2022-12-24 |
| 基金项目:上海市自然科学基金（21ZR1451400）；上海市嘉定区卫生和计划生育委员会基金(2021-KY-10、JDKW-2021-0014)；上海市嘉定区江桥医院“科技计划“项目(202127A、202131A) |
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| A preliminary study on the relationship between myocardial longitudinal contractility and arterial stiffness in patients with HFpEF |
| lijingzhi,wulingheng,chenjianxiong,shencuiqin,sunjiali,dulianfang,lizhaojun |
| (Department of Ultrasound, Mentougou Maternal and Child Health-Care Hospital;Department of Ultrasound, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine) |
| Abstract: |
| Objective To explore the relationship among myocardial diastolic function, myocardial contractility and aortic stiffness. Methods 29 patients with HFpEF and 53 age- and sex-matched control subjects were enrolled in this study. The arterial velocity pulse index (AVI), the parameters of structure Left ventricular interventricular septal thickness (IVSD), Left ventricular posterior wall thickness (LVPWD), Left ventricular diastolic function E/A and E/e’, myocardial longitudinal contractility global longitudinal strain (GLS), myocardial circumferential contractility global circumferential strain (GCS), global contractility Left ventricular ejection fraction (LVEF) were measured respectively. Intergroup comparisons were analyzed by independent samples t- tests, and correlation analysis were analyzed by Pearson correlation analysis and Logistic regression analysis. Results ① The arterial velocity pulse index (AVI) was higher in the HFpEF group than the control group (all P < 0.05). ② In the HFpEF group, IVSD and LVPWD were thicker (all P < 0.05), E/A decreased while E/e’ increased (all P < 0.01), longitudinal contractility GLS decreased (P < 0.01) than those in the control group, while the differences of myocardial circumferential contractility GCS and global contractility between the both groups were not statistically significant (all P >0.01). ③ The aortic stiffness AVI was negatively correlated with GCS (r=-0.241, P＜0.05), and positively correlated with E/e’ (r=0.288, P＜0.05) in univariate correlation analysis; AVI and LVPWD were negatively independent risk factor of HFpEF incidence in Logistic regression analysis, OR (95%CI) was 1.240 (1.045,1.471) and 2.448 (1.149,5.216) respectively. Conclusion The arterial stiffness increased, ventricular wall thickened, myocardial longitudinal contractility decreased, as the myocardial circumferential contractility and global contractility was normal in HFpEF patients. That changes were independently associated with arterial stiffness increasing and ventricular remodeling. |
| Key words: Echocardiography HFpEF Arterial velocity pulse index Global circumferential strain Global longitudinal strain Two-dimensional speckle tracking imaging |
