| 摘要: |
| 目的 利用心肌做功联合心肺运动试验(CPET)对HCM患者的预后进行评估，并探究心肌做功参数和CPET参数与左室壁厚度的相关性。方法 选取自2022年1月至2023年3月在福建省龙岩市第一医院确诊的非梗阻性HCM患者55例（男40例，女15例，平均年龄22-66岁），同时选取健康志愿者55例作为对照组。收集常规超声心动图数据并进行两组间比较。HCM患者及对照组进行心肺运动试验，比较两组心肺运动试验参数及心肌做功参数的差异，并对两组在心肺运动试验前后心肌做功的参数变化进行比较。结果 HCM组与对照组相比最大室壁厚度（MWT）、左房舒张末内径（LAD）、E/e’均明显增加，差异有统计学意义（P<0.05）。HCM 组与对照组相比心肺运动试验前左室心肌做功参数整体纵向应变（GLS）、及心肌做功指数（GWI）和有用功（GCW）均明显降低，纵向应变达峰时间离散度 （PSD）明显升高，差异具有统计学意义（P<0.05），而无用功（GWW）无明显统计学意义。HCM组与对照组相比心肺运动试验参数峰值摄氧量（Peak VO2）、无氧阈（AT）、氧脉搏（VO2/HR）和代谢当量（METs）均明显降低，差异有统计学意义（P<0.05）；VE/V?CO2斜率无明显升高。HCM组心肺运动试验前后GCW无明显升高，PSD明显升高；对照组心肺运动试验前后GCW明显升高相比，PSD无明显改变。左室最大室壁厚度与PSD呈正相关（r=0.88），与GCW呈负相关（r=-0.84），与VO2呈无明显负相关性（r=-0.48）。结论 心肌做功联合 CPET能够对HCM患者的预后进行有效评估，心肌有效做功参数与左室壁厚度呈负相关， CPET参数与左室壁厚度无明显相关性。 |
| 关键词: 心肌做功 心肺运动试验 肥厚型心肌病 预后评估 |
| DOI： |
| 投稿时间：2023-04-09修订日期：2023-05-08 |
| 基金项目:福建医科大学科研发展基金项目（2021QH1340）；龙岩市科技计划联合资金项目（2021LYF17037） |
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| Prognostic evaluation of myocardial work combined with cardiopulmonary exercise testing in patients with hypertrophic cardiomyopathy |
| Hou Shuhong,CHEN Dongping,SUN Linlin,LI Zhangjing,ZHANG Li,LIN Yufen,WU Bo |
| () |
| Abstract: |
| Objective To evaluate the prognosis of patients with HCM by myocardial work combined with cardiopulmonary exercise test (CPET), and to explore the correlation between myocardial work parameters, CPET parameters and left ventricular wall thickness. Methods A total of 55 patients with non-obstructive HCM (40 males and 15 females, average age 22-66 years) diagnosed in the First Hospital of Longyan City of Fujian Province from January 2022 to March 2023 were selected, and 55 healthy volunteers were selected as the control group. Routine echocardiographic data were collected and compared between the two groups. HCM patients and control group underwent cardiopulmonary exercise test. The differences of cardiopulmonary exercise test parameters and myocardial work parameters were compared between the two groups, and the changes of myocardial work parameters before and after cardiopulmonary exercise test were compared between the two groups. Results The maximum ventricular wall thickness (MWT), left atrial end-diastolic diameter (LAD) and E/e 'were significantly increased in the HCM group compared with the control group (P<0.05). Compared with the control group, the global longitudinal strain (GLS), myocardial work index (GWI) and active work (GCW) of the HCM group before cardiopulmonary exercise test were significantly decreased, and the time dispersion of longitudinal strain to peak (PSD) was significantly increased (P<0.05). However, no significant statistical significance was found in GWW. Compared with the control group, the Peak oxygen uptake (Peak VO2), anaerobic threshold (AT), oxygen pulse (VO2/HR) and metabolic equivalent (METs) of the HCM group were significantly decreased (P<0.05). There was no significant increase in the slope of VE/V?CO2. There was no significant increase in GCW and PSD before and after cardiopulmonary exercise test in HCM group. In the control group, GCW increased significantly before and after cardiopulmonary exercise test, but PSD did not change significantly. The maximal left ventricular wall thickness was positively correlated with PSD（r=0.88）， negatively correlated with GCW（r=-0.84）， and not negatively correlated with VO2（r=-0.48）. Conclusions Myocardial work combined with CPET can effectively evaluate the prognosis of patients with HCM. There is a negative correlation between myocardial work parameters and left ventricular wall thickness, while there is no significant correlation between CPET parameters and left ventricular wall thickness. |
| Key words: Myocardial work Cardiopulmonary exercise test Hypertrophic cardiomyopathy Prognostic assessment |
