斑点追踪技术评估射血分数中间值心力衰竭患者左室心肌功能的临床价值

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ABSTRACTObjectiveTo investigate clinical value speckle tracking imaging（STI） inassessing leftventricular myocardialfunctioninpatients withheartfailurewithmid-rangeejectionfraction（HFmrEF）.MethodsAtotal195patients with chronic heartfailure from departmentcardiologyinour hospital wereenrolled.Basedonleft ventricular ejectionfraction （LVEF），patientswere divided into three groups：heart failure with reduced ejection fraction（HFrEF）group（LVEF<40 % ）， HFmrEF group （ 40% ≤LVEF≤49 % ），and heart failure with preserved ejection fraction（HFpEF）group（LVEF≥5O%）.STI was usedtomeasure leftventricular myocardial function parameters，including global longitudinal strain（GLS），peak strain dispersion（PSD），global work index（GWI），and globalwork eficiency（GWE）.Thediferences inabove parameters amog threegroups werecompared.Thecorrelationsbetween STIparametersandLVEFwereanalyzed.Receiveroperatingcharacteristic （ROC）curvewasdrawn toanalyze diagnosticeficacy STI parameters fordifferentiating HFmrEFfrom HFrEF and HFmrEF from HFpEF.ResultsGLS，GWI，and GWE progresivelydecreased in HFpEF，HFmrEF，and HFrEF groups，with statistically significant differences in pairwise comparisons（all P<0.05 ）.PSDinHFrEF groupwassignificantly higher than thatin HFmrEFand HFpEF groups，with significant differences（both P<0.05 ）.There was no significant difference in PSD between HFmrEF groupand HEpEF group.Corelationanalysisshowed thatGLS，GWI，andGWEwere positively correlated with LVEF（r=0.85，0.74，0.72，allP<0.001），while PSD was negativelycorelated withLVEF（ r=-0.30，P<0.001 ） ROC curve analysis showedthat when cutfvalues for GLS，PSD，GWI，andGWE were-10.55%，60.5O ms，1051.5 mmHg%，and83.50%，respectively，areaundercurve（AUC）fordiferentiating HFmrEFfromHFrEFwere0.938，0.676， 0.890，and 0.885.When cutf values for GLS，GWI，and GWE were-11.35%，1428.5 mmHg%，and 87.50% ，respectively， AUC fordiferentiating HFmrEFfrom HFpEFwere0.929，0.877，and0.86.ConclusionSTIprovides precise assessment leftventricularmyocardial functioninpatientswithHFmrEF，eringvaluableimagingevidenceforitsindependent phenotyping and management.

KEYWORDSSpeckle tracking imaging；Heart failure with mid-range ejection fraction；Myocardial function， left ventricle

2016年欧洲心脏病学会发布的急慢性心力衰竭诊疗指南首次提出射血分数中间值心力衰竭（heartfailurewithmid-rangeejection fraction，HFmrEF）的概念，即将左室射血分数（LVEF）介于 40%～49% 的心力衰竭确立为独立亚型。（剩余9583字）