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Objective:To explore the application value of non-invasive myocardial work imaging in evaluating the cardiac function of ST-segment elevation myocardial infarction (STEMI) patients with left ventricular remodeling (LVR) after percutaneous coronary intervention (PCI).Methods:One hundred and twenty-six patients with STEMI undergoing PCI in General Hospital of Ningxia Medical University from December 2021 to September 2022 were prospectively collected and divided into left ventricular remodeling group (LVR group, 34 cases) and non left ventricular remodeling group (NLVR group, 92 cases) according to whether there was left ventricular remodeling 3 months after surgery. General data were collected. Routine echocardiography and noninvasive myocardial work imaging were performed before, 1 week, 1 month, and 3 months after surgery, the differences in the above parameters between the two groups were compared. Pearson correlation analysis was used to analyze the correlation between the indicators.Logistic regression analysis was used to determine the independent risk factors of left ventricular remodeling after STEMI, and a predictive model was obtained. The diagnostic value of the model was judged by ROC curve.Results:①General information comparison: There were statistically significant differences between the two groups in BMI, systolic blood pressure, diastolic blood pressure, average number of stents implanted, and history of hyperlipidemia (all P<0.05), but there was no significant difference in other data (all P>0.05). There was no statistically significant difference in two-dimensional transthoracic echocardiography (2D-TTE) parameters and non-invasive myocardial work (MW) parameters between the two groups before and 1 week after operation (both P>0.05). ②2D-TTE parameter comparison: LVESV and LVEDV at 3 months after PCI in the LVR group were significantly higher than those in the NLVR group, and LVEF and E/A were significantly lower than those in the NLVR group (all P<0.05); There were no significant differences in other indexes between the two groups by conventional echocardiography at 3 months after PCI(all P>0.05). ③Comparisons of noninvasive myocardial work parameters: GLS, GWE, GWI, GCW at 1 month and 3 months after PCI in the LVR group were significantly lower than those in the NLVR group, and GWW were significantly higher than those in the NLVR group ( P<0.001). ④Correlation analysis: GLS, GWE, GCW, GWI and LVEDV were negatively correlated at 1 month after operation ( r=-0.42, -0.38, -0.50, -0.53, all P<0.001), GWW was positively correlated with LVEDV ( r=0.45, P<0.001). ⑤Logistic regression analysis: GLS<17%, GCW<1 900 mmHg%, GWW>105 mmHg%, and GWE<90 mmHg% at 1 month after PCI were independent predictors for LVR in STEMI patients after PCI (all P<0.05). The predictive model was Logit (P)=0.692GLS+ 0.804GCW+ 0.972GWW+ 0.880GWE. The AUC of this model was 0.886, 95% CI=0.845-0.926, which was significantly higher than single index, the sensitivity was 0.86, and the specificity was 0.79. Conclusions:GLS, GWE, GWI, GCW are positively correlated with LVR, while GWW is negatively correlated with left ventricular remodeling. Noninvasive myocardial work parameters are independent risk factors for left ventricular remodeling in patients with STEMI after PCI surgery. This technique can be used to evaluate LVR and has great clinical application value.
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Objective:To detect the changes of left ventricular myocardial work parameters, and evaluate the left ventricular systolic function in patients with hyperglycemia during pregnancy by left ventricular pressure-strain loop (PSL).Methods:From June 2021 to March 2022, 97 pregnant women who were admitted to the Second Affiliated Hospital of Harbin Medical University and clinically diagnosed as gestational hyperglycemia were prospectively and randomly selected. According to the blood glucose level, the patients were divided into gestational dominant diabetes mellitus (ODM) group(39 cases) and gestational diabetes mellitus (GDM) group(58 cases). Meanwhile, another 62 healthy pregnant women were selected as control group. The basic clinical data of the pregnant women were collected, and the conventional two-dimensional parameters of the heart were collected. The global longitudinal strain (GLS) was analyzed by two-dimensional speckle tracking technique. Then the cuff blood pressure was used as the left ventricular pressure to construct a non-invasive left ventricular pressure-strain loop. The global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) of each group were calculated and compared. The correlation between myocardial performance parameters and GLS, glycated hemoglobin(HbA 1c) were analyzed, and the independent factors affecting left ventricular systolic function were obtained by Logistic regression analysis. Twenty cases were randomly selected from the study subjects, and the intraclass correlation coefficients(ICC) of within the observers and between observers were calculated for repeatability test. Results:①Conventional ultrasound parameters: There were no significant differences among the three groups (all P>0.05). ②GLS and left ventricular myocardial performance parameters: GWI, GWE, GCW and GLS in GDM and ODM groups were significantly lower than those in control group (all P<0.001), GWW was significantly higher than control group ( P<0.001); GWI, GWE, GCW and GLS in ODM group were lower than those in GDM group (all P<0.001), while GWW was higher than control group ( P<0.001). ③GWE, GWI and GCW were negatively correlated with GLS ( r=-0.525, -0.408, -0.435; all P<0.05), GWW was positively correlated with GLS ( r=0.348, P<0.05). GWE, GWI and GCW were negatively correlated with HbA 1c ( r=-0.325, -0.262, -0.250; all P<0.05), while GWW was positively correlated with HbA 1c ( r=0.175, P<0.05). ④GWE, 1 h oral glucose tolerance test and HbA 1c were the influencing factors of left ventricular systolic function in patients with hyperglycemia during pregnancy. ⑤The predictive values of GWI, GWE, GCW, GWW and GLS for cardiac function in patients with gestational hyperglycemia were high, and the predictive value of GWE was the highest (AUC: 0.87, the best truncation value: 94.5%, specificity: 0.76, sensitivity: 0.82) and better than GLS. ⑥The repeatability of myocardial work parameters was better in both groups. Conclusions:Myocardial work parameters obtained by PSL are early and sensitive parameters for evaluating left ventricular systolic function impairment in patients with hyperglycemia during pregnancy which can provide reliable and objective quantitative indicators for early clinical intervention and improvement of prognosis.
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Objective:To evaluate left ventricular systolic function and myocardial perfusion in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) by left ventricular pressure-strain loop (PSL).Methods:From August 2020 to December 2020, 47 patients with AMI admitted to the Intensive Care Unit of Cardiovascular Department of the First People′s Hospital of Foshan and treated with PCI were selected. Myocardial contrast echocardiography (MCE) and conventional echocardiography were performed within 72 hours after operation (T1 phase) and conventional echocardiography was repeated 3 months later (T2 phase). Myocardial perfusion scores (MPS) of left ventricular segments were obtained by MCE and the overall myocardial perfusion score index (PSI) was calculated. According to PSI, the patients were divided into good perfusion group and poor perfusion group. Conventional ultrasonic parameters and two-dimensional global longitudinal strain (2D-GLS) were collected. Left ventricular PSL analyzed in off-line EchoPAC software was used to evaluate the left ventricular myocardial work index, including global work index (GWI), global constructive work (GCW), global waste work (GWW), global work efficiency (GWE). The differences of parameters between patients with different perfusion levels and the change of parameters with time at the same perfusion level were compared. ROC curves were used to analyze the diagnostic values of strain parameters and myocardial work parameters in patients with hypoperfusion.Results:There were no significant differences in conventional ultrasound parameters between groups in T1 and T2 phases (all P>0.05), while there were significant differences in 2D-GLS and myocardial work parameters (except GWI in T2 phase) (all P<0.05). The absolute values of 2D-GLS and myocardial work parameters (except GWW ) were higher than those in T1 phase (all P<0.05). There was no significant difference in GWW ( P>0.05), but it decreased in good perfusion group while increased in poor perfusion group over time. ROC curve analysis showed that 2D-GLS, GWI, GCW and GWE had high area under the curve. Conclusions:Left ventricular PSL provides a new sensitive method for the evaluation of cardiac function in patients with AMI after PCI, and is expected to become a new index for the preliminary evaluation of microcirculation.
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Objective:To evaluate the application value of left ventricular pressure-strain loop (PSL) in patients with rheumatoid arthritis (RA) by the PSL.Methods:From April 2020 to June 2021, 75 RA patients(case group) and 35 healthy physical examination person(control group) were selected from the Affiliated Hospital of Inner Mongolia Medical University.According to the disease activity scores 28(DAS28) joint disease range of activity score, the patients were divided into low range of activity group (16 cases), medium range of activity group (35 cases) and high range of activity group (24 cases). Echocardiographic examinations were performed on all patients, conventional ultrasound data were collected and the left ventricular PSL technology was used to analyze the myocardial work parameters, including global work index (GWI), global constructive work (GCW), global waste work (GWW) and global work efficiency (GWE). The mean values of myocardial work index (MWI), constructive work (CW), waste work (WW) and work efficiency (WE) were calculated. The differences of myocardial work parameters between the case groups and the control group were compared, and the correlation analysis of myocardial work parameters with global longitudinal strain of left ventricle(LVGLS), left ventricular ejection fraction(LVEF) and DAS28 scores were conducted.Results:①There were no statistically significant differences of clinical data between each case group and the control group (all P>0.05). ②Compared with the control group and low disease activity group, the LVGLS of medium and high disease activity groups decreased obviously (all P<0.05). ③The GWI and GCW of the medium and high disease activity groups were significantly lower than those of the control group (all P<0.05), and there were no statistically significant differences of GWW and GWE between the case groups and the control group (all P>0.05). The mid-segment MWI, apical MWI and CW of the medium and high disease activity case groups, and the mid-segment CW of the medium disease activity case group were lower than those of the control group (all P<0.05). ④In the case group, GWI, GCW and LVEF were significantly and positively correlated ( rs1=0.253, P=0.008; rs2=0.261, P=0.024), and were significantly negatively correlated with LVGLS ( rs1=-0.525, P<0.001; rs2=0.455, P<0.001). There were no significant correlations between myocardial work parameters and DAS28 score (all P>0.05). Conclusions:PSL can early reflect to the impaired cardiac function of RA patients with moderate and high disease activity, and provide a new imaging method for clinical evaluation of the cardiac function of patients.
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Objective:To observe the effects of bilateral thoracic paravertebral block (TPVB) on left ventricular myocardial work using pressure-strain loop(PSL) in patients before off-pump coronary artery bypass graft(OPCABG).Methods:A total of 24 patients with coronary heart disease undergoing selective OPCABG were recruited in the First Affiliated Hospital of Nanjing Medical University from May to August 2021. All patients underwent ultrasound-guided TPVB preoperatively. Left ventricular global work, including global longitudinal strain(GLS), global work index(GWI), global constructive work(GCW), global waste work(GWW), global work efficiency(GWE), and regional work, including myocardial work index(MWI), myocardial work efficiency(MWE) were observed before TPVB and 20 minutes after TPVB.Results:The parameters of heart rate and left ventricular outflow tract blood flow were decreased [(69.13±10.72)bpm vs (65.46±9.66)bpm, P=0.010; (13.86±2.83)ml vs (12.72±2.60)ml, P=0.017]. The MWI in regional segments of hypokinesis and akinesis were significantly improved [hypokinesis: (1 175.76±206.64)mmHg% vs (1 349.38±462.35)mmHg%, P=0.004; akinesis: (684.94±251.39)mmHg% vs (965.35±384.33)mmHg%, P=0.001] and the MWE in regional segments of hypokinesis and akinesis were improved [hypokinesis: (87.79±7.46)% vs (90.35±6.39)%, P=0.029; akinesis: (70.24±18.03)% vs (80.15±16.65)%, P=0.021]. There were no significant changes in MWI, MWE, LVEF, GLS, GWI, GCW, GWW and GWE(all P>0.05). Conclusions:Based on PSL, the changes of left ventricular work in patients with OPCABG before and after TPVB show that TPVB can improve the blood supply of the ischemic myocardium, which provides a reliable basis for optimizing the perioperative anesthesia management.
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Objective:To observe the feasibility of evaluating right ventricular (RV) function by the method based on left ventricle (LV) pressure-strain ring (PSL) technique in patients with systemic lupus erythematosus (SLE), and to evaluate the efficacy of non-invasive PSL in the diagnosis of dysfunction of both LV and RV.Methods:Thirty-nine patients were enrolled with SLE who were admitted to the Affiliated Hospital of Inner Mongolia Medical University from March 2020 to September 2021 and 57 sex- and age-matched healthy controls underwent assessment by conventional echocardiography, two-dimensional speckle tracking imaging (2D-STI) and myocardial work (MW). The echocardiographic parameters were compared between the groups. The correlations between RVMW parameters and conventional echocardiographic parameters, and between MW parameters and SLEDAI-2K score were analyzed by Spearman correlation analysis.Results:①The two groups did not show any difference at the conventional echocardiographic parameters of the LV systolic function ( P>0.05). In the SLE group, tricuspid regurgitation maximal velocity (TR V max) and right ventricular index of myocardial performance (RIMP) increased, tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular S′ (S′ tv) decreased (all P<0.05), and others did not show statistical difference (all P>0.05). ②The 2D-STI parameters: There were no significant differences in left ventricular global longitudinal strain (LV GLS) ( P>0.05), however RVGLS decreased ( P<0.05). ③The MW parameters of LV and RV: including global constructive work (GCW), global work index (GWI), global wasted work (GWW), and global work efficiency (GWE). In SLE group, LV GWE, RV GWE decreased and LV GWW, RV GWW increased ( P<0.05), others were no significant differences ( P>0.05). ④The correlation analysis: RV GWI positively correlated with TR V max ( rs=0.481). RV GCW positively correlated with TR V max ( rs=0.587). RV GWW positively correlated with right atrial area (RAA) and TR V max ( rs=0.429, 0.610), negatively correlated with S′ tv ( rs=-0.342). RV GWE positively correlated with S′ tv ( rs=0.326) and negatively correlated with RAA ( rs=-0.462) (all P<0.05). SLEDAI-2K score was negatively correlated with LV GLS ( rs=-0.333) and LV GWI ( rs=-0.326) ( P<0.05). Conclusions:The study has shown the impaired systolic function of both LV and RV in patients with SLE. PSL technique, especially RVMV based on LV PSL technique might emerged as a novel measure to evaluate systolic dysfunction in SLE patients.
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Objective:To evaluate left ventricular myocardial work in pregnant women with impaired glucose tolerance(IGT) in the third trimester by the non-invasive technical parameters of pressure-strain loop(PSL), and to explore its predictive value of risk of perinatal adverse events.Methods:From October 2020 to October 2021, 70 pregnant women of IGT and 50 healthy pregnant women in Henan Provincial People′s Hospital were included, and a 75 g oral glucose tolerance test(OGTT) was performed at 24-28 weeks. Then their routine obstetric examinations were followed up until one week postpartum and perinatal adverse events were recorded, such as diabetic mother-infant syndrome, macrosomia, et al. After 36 weeks of pregnancy before childbirth, echocardiography was performed and dynamic images of 3-5 cardiac cycles at apical four-chamber view, three-chamber view, and two-chamber view were recorded.Simultaneously, pressure-strain loop(PSL) curve, left ventricular global longitudinal strain(GLS), global work index(GWI), global constructive work(GCW), global wasted work(GWW) and global work efficiency(GWE) were calculated through the EchoPAC 203 workstation. Then the differences of all parameters were compared between the two groups. And a prediction model for perinatal adverse events was built by binary logistic regression, and ROC curve was used to analyze the prediction efficiencies of the prediction model and each independent influencing factor.Results:Compared with the control group, the absolute values of GLS, GWI and GCW of IGT group were lower(all P<0.05). The incidence of perinatal adverse events of the IGT group, including adverse pregnancy outcomes and neonatal adverse outcomes, was higher than that in the control group( P<0.05). According to logistic regression model, the GLS, GWI, GCW and 2-hour postprandial blood glucose(2-hPBG) were independent influencing factors for perinatal complications(all P<0.05); in addition, ROC curve anaysis showed the area under the curve of the predictive model based on the influencing factors, GLS, GWI, GWE and 2-h PBG were respectively 0.903, 0.820, 0.879, 0.854 and 0.771. Conclusions:The parameters of PSL can quantitatively assess the changes of left ventricular myocardial work in pregnancy women with IGT; and the incidence of perinatal adverse events in IGT pregnant women is higher; GWI, GCW, the models constructed based on GLS, GWI, GCW and 2-hPBG have potential values in predicting the risk of perinatal adverse events.
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Objective:To explore the application value of non-invasive pressure-strain loop (PSL) in evaluating left ventricular systolic function of young strength athletes with different heart rates.Methods:Thirty-five young wrestlers were collected randomly and divided into 2 groups according to the heart rate: group 1 (heart rate of 40-59 beats/min, n=20) and group 2 (heart rate of 60-80 beats/min, n=15). Thirty healthy young males were selected as the control group at the same period. Non-invasive PSL was used to obtain left ventricular global longitudinal strain (GLS), longitudinal peak strain dispersion (PSD), global myocardial work index (GWI), global constructive myocardial work (GCW), global wasted myocardial work (GWW) and global myocardial work efficiency (GWE) in three groups, and the differences between them were measured. Results:Compared with the control group, GWE in the athlete group 1 and 2 reduced, PSD, GWW were increased, and GWI, GCW in the athlete group 1 were decreased, and all differences were statistically significant (all P<0.05). Compared with the athlete group 1, PSD, GWI, GCW, GWW in the athlete group 2 increased and GWE was reduced (all P<0.05). Conclusions:PSL can quantitatively evaluate the left ventricular myocardial work of young strength athletes with different heart rates, and then assess the effect of heart rates on the left ventricular systolic function of athletes.
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Objective:To evaluate the global and segmental myocardial work in patients with cardiac amyloidosis (CA) by left ventricular pressure-strain loop (PSL) noninvasively.Methods:Eighteen patients with CA in Beijing Chao-Yang Hospital from March 2018 to December 2020 were included as CA group, 20 healthy subjects were selected as control group. The global longitudinal strain (GLS) and mechanical dispersion (MD) of left ventricle were analyzed by two-dimensional speckle tracking imaging. The left ventricular PSL was used to assess global work index (GWI), global constructive work (GCW), global waste work (GWW), and global work efficiency (GWE). The mean value of left ventricular basal, mid and apical myocardial work index (MWI), constructive work (CW), waste work (WW) and work efficiency (WE) were calculated and compared between the two groups.Results:①Compared with the control group, GLS was decreased and MD was increased in CA group (all P<0.05). ②GWI, GCW, GWW and GWE were decreased in CA group compared with the control group (all P<0.05). ③In CA group, the MWI, CW and WE of the basal, mid and apical segments were lower than those of control group (all P<0.05), WW of the basal and mid segments were lower than those of apical segment(all P<0.05). The impairment of MWI, WW and WE in basal and mid segment were more significant than those of apical segment (all P<0.05). ④GWI, GCW and GWE were positively correlated with GLS ( r=0.854, 0.816, 0.748; all P<0.001) and LVEF ( r=0.674, 0.634, 0.650; all P<0.01), and negatively correlated with MD ( r=-0.657, -0.672, -0.710, all P<0.01). GWI and GCW were negatively correlated with E/e′ ( r=-0.493, -0.539; all P<0.05). Conclusions:The global, basal, mid and apical left ventricular myocardial work indices are decreased in CA patients. MWI, CW and WE show an apical sparing pattern. Quantitative assessment of myocardial work by PSL may provide more valuable information for CA patients.
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Objective:To discuss the quantitative evaluation of left ventricular systolic function in patients with light-chain amyloidosis (AL) by pressure-strain loop (PSL).Methods:Forty-six patients with clinically diagnosed as AL in the Affiliated Tumor Hospital of Zhengzhou University from January 2018 to December 2020 were selected as case group, and they were divided into 2 groups according to whether the thickness of interventricular septum and posterior wall at end-diastole was >12 mm; ①cardiac amyloidosis (CA) group (21 cases, the thickness>12mm); ②non cardiac amyloidosis (NCA) group (25 cases, the thickness≤12 mm). Twenty five healthy volunteers were selected as control group at the same time. Routine echocardiography was performed in all subjects.Two-dimensional dynamic images of the left ventricular apical two-chamber, three-chamber, and four-chamber views were collected for three consecutive cardiac cycles using two-dimensional speckle-tracking. A tracing analysis was conducted and blood pressure was entered on the off-line Echo PAC 203 software, and the left ventricular global longitudinal strain (GLS), peak strain time dispersion(PSD), global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) were obtained. The differences of GLS, PSD and myocardial work (GWI, GCW, GWW, GWE) parameters were compared between groups, and Pearson correlation was used to analyze the correlations.Results:①Routine echocardiography: Compared with the control group and NCA group, inter-ventricular septum thickness (IVST), left ventricle posterior wall thickness (LVPWT), left ventricular mass index (LVMI), left atrial diameter (LAD), and E/e′ in CA group were increased, while left ventricular ejection fraction (LVEF) was decreased; ②Compared with the control group, GLS, GWI, and GCW in NCA group were decreased, while there were no statistically differences in GWE, PSD, and GWW between the two groups (all P>0.05); Compared with the control group and NCA group, GLS, GWI, GCW, and GWE were obviously decreased, while PSD and GWW were obviously increased in CA group.③ Correlation analysis showed that: the absolute value of GLS was positively correlated with GWI, GCW and GWE ( r=0.654, 0.695, 0.788; all P<0.001), and negatively correlated with GWW, and PSD ( r=-0.710, -0.625; all P<0.001). Besides, PSD had negative correlation with GWI, GCW and GWE ( r=-0.754, -0.653, -0.702; all P<0.001), and positive correlation with GWW ( r=0.676, P<0.001). Conclusions:PSL can quantitatively evaluate the left ventricular systolic function of AL patients, while the myocardial work parameters are conducive to evaluate the degree of cardiac involvement in the course of AL patients.
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Objective@#To explore the application value of pressure-strain loop (PSL) in evaluating left ventricular myocardial work (MW) in patients with chronic heart failure (CHF).@*Methods@#Seventy patients with CHF were selected as case group(CHF group) and were divided into 2 groups according to the left ventricular ejection fraction (LVEF) in ultrasonic cardiogram: LVEF preserve group (HFpEF group, LVEF≥50%, n=35) and LVEF reduced group (HFrEF group, LVEF<50%, n=35). Thirty-three healthy volunteers were selected as control group at the same period. Two-dimensional dynamic images in apical two chamber, three chamber and four chamber views were collected by two-dimensional speckle-tracking. Using the off-line EchoPAC software, a tracing analysis was conducted and the blood pressure was entered to obtain left ventricular global longitudinal strain (GLS), global MW index (GWI), global constructive work (GCW), global wasted work (GWW) and MW efficiency (GWE). The differences of GLS and MW parameters (GWI, GCW, GWW, GWE) were compared between each groups, and Pearson correlation was used to analyze the correlation between MW parameters and LVEF.@*Results@#Compared with the control group and HFpEF group, the left atrial dimension(LAD), left ventricular end-diastolic dimension(LVDd), left ventricular end-diastolic volume(LVEDV), left ventricular end-systolic volume(LVESV) in HFrEF group increased, while LVEF decreased significantly(P<0.05). Compared with the control group, LAD in HFpEF group increased, the vaules of GLS, GWI, GCW were obviously lower in HFpEF group and HFrEF group(all P<0.05), GWW was higher and GWE was lower in HFrEF group(all P<0.05). GLS, GWI, GCW, GWE decreased and GWW increased in HFrEF group than those in HFpEF group, and all the differences were statistically significant(all P<0.05). In CHF group, GWW was negatively correlated with LVEF (r=-0.521, P<0.001) while positive correlations between GWI, GCW, GWE and LVEF were discovered (r=0.846, 0.807, 0.788; all P<0.001).@*Conclusions@#PSL can effectively evaluate the left ventricular MW in CHF patients. It has a certain correlation with LVEF and can reflect left ventricular systolic function. It provides a new reference index for the clinical diagnosis and evaluation of prognosis in CHF patients.