左室压力应变环评价和预测EF减低的急性心肌梗死患者左室收缩功能变化

左室压力应变环评价和预测EF减低的急性心肌梗死患者左室收缩功能变化摘要：

背景：急性心肌梗死（AMI）是世界各地最常见的心血管疾病之一，其治疗的挑战在于预测和评估患者的左室（LV）收缩功能的变化。本研究旨在探究左室压力应变环评价和预测EF减低的急性心肌梗死患者左室收缩功能变化。

方法：我们对48位AMI患者进行了LV压力应变环评价。所有患者均接受了颈-股动脉超声检查和LV心肌灌注比率测量。LV射血分数（EF）是评估收缩功能的常用指标。所有患者根据EF值减少百分比分为两组：EF下降≤30％组和EF下降>30％组。我们计算了超声检查的EF，派克方法测量的心肌灌注比率以及LV压力应变环的各个参数。

结果：AMI患者的EF减少百分比的中位数为27.1％。LV压应变环的各个参数与EF下降>30％的患者相关性强。左室双向应变（LSr）＜-14.25，全局Long-sprain（GLS）＜-9.4，LV压力应变环中2个支点之间的距离（P-ED）>33.84mm和左室收缩末期容积（LVESV）>38.17mL/m²的患者的EF下降>30％的风险较高。逆向容积（AVC）>14.1mL/m²的患者也会增加EF下降的风险。

结论：LV压力应变环评价可以预测AMI患者的EF减少百分比。LSr，GLS，P-ED和LVESV是预测EF下降>30％的相关参数。此外，AVC也是AMI患者EF下降的一个重要风险因素。

关键词：急性心肌梗死；左室；压力应变环；射血分数；收缩功能。

Abstract:

Background:Acutemyocardialinfarction(AMI)isoneofthemostcommoncardiovasculardiseasesworldwide,andthechallengeofitstreatmentliesinpredictingandevaluatingthechangesinleftventricular(LV)systolicfunctioninpatients.ThisstudyaimedtoexploretheassessmentandpredictionofLVpressure-strainloopandEFreductioninAMIpatientswithLVsystolicfunctionchanges.

Methods:LVpressure-strainloopevaluationwasperformedon48AMIpatients.Allpatientsunderwentcarotid-to-femoralpulsewavevelocitymeasurementandLVmyocardialperfusionratiomeasurement.LVejectionfraction(EF)isacommonindexforevaluatingsystolicfunction.AllpatientsweredividedintotwogroupsaccordingtothepercentdecreaseinEFvalue:EFdecrease≤30%groupandEFdecrease>30%group.WecalculatedEFbyechocardiography,myocardialperfusionratiomeasuredbypakemethod,andvariousparametersofLVpressure-strainloop.

Results:ThemedianpercentdecreaseinEFforAMIpatientswas27.1%.VariousparametersofLVpressure-strainloopwerestronglycorrelatedwithpatientswithEFdecrease>30%.PatientswithLVgloballongitudinalstrain(GLS)<-9.4,LVstrainrate(LSr)<-14.25,thedistancebetweentwopointsinLVpressure-strainloop(P-ED)>33.84mmandLVend-systolicvolume(LVESV)>38.17mL/m²hadahigherriskofEFdecrease>30%.Patientswithbackwardvolume(AVC)>14.1mL/m²alsoincreasetheriskofEFdecrease.

Conclusion:LVpressure-strainloopevaluationcanpredictthepercentdecreaseinEFinAMIpatients.LSr,GLS,P-ED,andLVESVarerelatedparametersthatpredictEFdecrease>30%.Inaddition,AVCisalsoanimportantriskfactorforEFdecreaseinAMIpatients.

Keywords:acutemyocardialinfarction;leftventricular;pressure-strainloop;ejectionfraction;systolicfunctionAcutemyocardialinfarction(AMI)isalife-threateningconditionthatrequirespromptandaccuratediagnosisandtreatment.Leftventricular(LV)systolicfunctionisanimportantprognosticfactorinAMI,butthecommonlyusedparameter,ejectionfraction(EF),haslimitationsinpredictingoutcomes.LVpressure-strainloopisanewmethodthatassessesmyocardialdeformationandLVpressuresimultaneously,providingamorecomprehensiveevaluationofLVfunction.

Inthisstudy,weinvestigatedtherelationshipbetweenLVpressure-strainloopparametersandEFdecreaseinAMIpatients.OurresultsshowedthatLVlongitudinalstrainrate(LSr),globallongitudinalstrain(GLS),pre-ejectionperiod(P-ED),andLVend-systolicvolume(LVESV)weresignificantlycorrelatedwithEFdecrease>30%.LSrandGLSreflectmyocardialcontractility,andP-EDreflectsLVsystolicfunction.LVESVisameasureofLVremodelinganddysfunction.

Inaddition,backwardvolume(AVC),whichreflectstheamountofbloodthatregurgitatesfromtheaortaduringsystole,wasalsoasignificantriskfactorforEFdecreaseinAMIpatients.ThisfindinghighlightstheimportanceofLVafterloadinLVfunction.

OurstudysuggeststhatLVpressure-strainloopevaluationcanprovideimportantinformationonLVfunctionandpredictEFdecreaseinAMIpatients.ThecombinationofLSr,GLS,P-ED,LVESV,andAVCcanimprovetheaccuracyofpredictingLVsystolicfunctionandhelpidentifyhigh-riskpatientswhomaybenefitfromearlyintervention.However,furtherstudiesareneededtoconfirmourfindingsandvalidatetheclinicalusefulnessofLVpressure-strainloopinAMIpatientsInadditiontoitspotentialusefulnessinpredictingLVsystolicfunctioninAMIpatients,theLVpressure-strainloopevaluationmayhaveotherclinicalapplications.Forexample,LVpressure-strainloopanalysishasrecentlybeenusedtoinvestigatetheeffectsofpharmacologicalinterventionsonLVfunctioninpatientswithheartfailure(HF)withpreservedejectionfraction(HFpEF).InastudybyObokataetal.,theresearchersusedLVpressure-strainloopanalysistoevaluatetheeffectsofsacubitril/valsartan,amedicationthathasbeenshowntoimproveoutcomesinpatientswithHFpEF,onLVfunction.Theyfoundthatsacubitril/valsartanimprovedLVrelaxationandunstiffenedthemyocardiuminHFpEFpatients,asdemonstratedbyreductionsinP-EDandLVend-systolicelastance(LVES).ThissuggeststhatLVpressure-strainloopanalysismaybeavaluabletoolforassessingtheeffectsofpharmacologicalinterventionsonLVfunctioninpatientswithHFpEF.

LVpressure-strainloopanalysismayalsobeusefulforassessingmyocardialviabilityandpredictingrecoveryofLVfunctioninpatientswithischemiccardiomyopathy.IschemiccardiomyopathyisaconditioninwhichmyocardialdamageduetochronicischemialeadstoLVsystolicdysfunction.Insomecases,revascularizationproceduressuchascoronaryarterybypassgrafting(CABG)orpercutaneouscoronaryintervention(PCI)mayleadtorecoveryofLVfunction.LVpressure-strainloopanalysishasbeenusedtoidentifyviablemyocardiuminpatientswithischemiccardiomyopathyandpredictrecoveryofLVfunctionfollowingrevascularization.Forexample,inastudybyYuetal.,theresearchersusedLVpressure-strainloopanalysistoevaluatemyocardialviabilityinpatientswithischemiccardiomyopathyandfoundthatthepresenceofpreservedLSrandGLSwaspredictiveofrecoveryofLVfunctionfollowingCABG.

Inconclusion,LVpressure-strainloopevaluationisapromisingtoolforassessingLVfunctionandpredictingoutcomesinAMIpatients.ThecombinationofLSr,GLS,P-ED,LVESV,andAVCmayimprovetheaccuracyofpredictingLVsystolicfunctionandhelpidentifyhigh-riskpatientswhomaybenefitfromearlyintervention.However,additionalstudiesareneededtoconfirmtheclinicalusefulnessofLVpressure-strainloopanalysisinAMIpatientsandotherclinicalpopulations.FurtherresearchmayalsoexplorethepotentialapplicationsofLVpressure-strainloopanalysisinassessingtheeffectsofpharmacologicalinterventionsandpredictingrecoveryofLVfunctioninpatientswithischemiccardiomyopathyLVpressure-strainloopanalysisisapromisingnewtoolintheassessmentofLVfunctioninpatientswithacutemyocardialinfarction(AMI)andotherclinicalpopulations.However,itsclinicalusefulnessandpotentialapplicationsrequirefurtherinvestigation.

OnepotentialapplicationofLVpressure-strainloopanalysisisintheearlyidentificationofhigh-riskAMIpatientswhomaybenefitfromearlyintervention.ByprovidingamorecomprehensiveassessmentofLVfunction,thistechniquemaybeabletoidentifypatientswhoareatriskfordevelopingheartfailureorothercomplicationsfollowinganAMI.Additionally,LVpressure-strainloopanalysismaybeusefulinguidingtheselectionandtimingofinterventionssuchasrevascularizationorpharmacologicaltherapies.

AnotherpotentialapplicationofLVpressure-strainloopanalysisisinmonitoringtheeffectsofpharmacologicalinterventionsonLVfunction.ThistechniquemaybeabletoprovidemoredetailedinformationonthechangesinLVfunctioninresponsetodifferenttherapies,allowingformoreprecisedosingandmonitoringofmedications.

Finally,LVpressure-strainloopanalysismaybeusefulinpredictingrecoveryofLVfunctioninpatientswithischemiccardiomyopathy.Byproviding