【摘要】 目的 应用左室压力-应变环（LVPSL）定量评估肥厚型心肌病（HCM）患者心肺运动试验（CPET）前后左室心肌做功变化。方法 选取我院经超声心动图或心脏MRI确诊的非梗阻性HCM患者55例（HCM组）和同期健康志愿者55例（对照组），应用常规超声心动图测量左室舒张末期内径（LVEDd）、左室收缩末期内径（LVEDs）、左房收缩末期内径（LAD）、舒张末期室壁厚度（MWT）、左室射血分数（LVEF）及二尖瓣口舒张早期血流峰值速度与二尖瓣环舒张早期运动峰值速度比值（E/e’），二维斑点追踪及LVPSL技术获取CPET前后整体纵向应变（GLS）、纵向应变达峰时间离散度（PSD）及左室心肌整体做功指数（GWI）、整体有用功（GCW）、整体无用功（GWW），比较两组上述参数的差异。结果 HCM组MWT、LAD、E/e’均较对照组增加，差异均有统计学意义（均P<0.05）；两组LVEDd、LVEDs、LVEF比较差异均无统计学意义。CPET前，HCM组GLS、GCW、GWI均较对照组减低，GWW、PSD均较对照组增加，差异均有统计学意义（均P<0.05）;CPET后，HCM组GLS、GCW、GWI均较对照组减低，GWW、PSD均较对照组增加，差异均有统计学意义（均P<0.05）。HCM组CPET后GLS较CPET前减低，PSD较CPET前增加，差异均有统计学意义（均P<0.05）;HCM组CPET前后GCW、GWW、GWI比较差异均无统计学意义。对照组CPET后GCW、GWW、GWI均较CPET前增加，差异均有统计学意义（均P<0.05）;CPET前后GLS、PSD比较差异均无统计学意义。结论 LVPSL可定量评估HCM患者CPET前后左室心肌做功变化，为临床早期干预、优化治疗策略、指导个体化运动提供参考依据，具有一定的临床参考价值。更多还原

【Abstract】 Objective To quantitatively evaluate the changes of left ventricular myocardium function before and after cardiopulmonary exercise test(CPET)in patients with hypertrophic cardiomyopathy(HCM)by left ventricular pressure-strain loop(LVPSL).MethodsFifty-five patients with non-obstructive HCM diagnosed by echocardiography or cardiac MRI in our hospital(HCM group) and 55 healthy volunteers during the same period(control group) were selected.Conventional echocardiography was used to measure left ventricular end-diastolic internal diameter(LVEDd),left ventricular end-systolic internal diameters(LVEDs),left atrial end-systolic internal diameters(LAD),end-diastolic ventricular wall thickness(MWT),left ventricular ejection fraction(LVEF),and the ratio of early diastolic peak flow velocity at the mitral valve to early diastolic peak velocity at the mitral annulus(E/e’).Two-dimensional speckle-tracking and LVPSL technology were used to obtain the global longitudinal strain(GLS),peak strain dispersion(PSD),global work index(GWI),global constructive work(GCW)and global wasted work(GWW)before and after CPET.The differences of above parameters between the two groups were compared.ResultsCompared with control group,MWT,LAD and E/e’were increased in HCM group,and the differences were statistically significant(all P<0.05).There were no significant differences in LVEDd,LVEDs and LVEF between the two groups.Before CPET,GLS,GCW and GWI in HCM group were decreased compared with those in control group,while GWW and PSD were increased,with statistical significance(all P<0.05).After CPET,GLS,GCW and GWI in HCM group were decreased compared with those in control group,while GWW and PSD were increased,with statistical significance(all P<0.05).GLS decreased and PSD increased in HCM group after CPET compared with those before CPET,with statistically significant differences(all P<0.05).There were no significant differences in GCW,GWW and GWI before and after CPET in HCM group.In control group,GCW,GWW and GWI increased after CPET compared with those before CPET,with statistically significant differences(all P<0.05).There were no statistically significant differences in GLS and PSD before and after CPET in the control group.ConclusionLV-PSL can quantitatively evaluate the changes of left ventricular myocardial work before and after CPET in HCM patients,providing a reference basis for early clinical intervention,optimization of treatment strategies,and individualized exercise guidance,which has good clinical reference value.更多还原