左心室压力-应变环技术评估鼻咽癌化疗患者左心室心肌功能的临床意义

Clinical significance of the left ventricular pressure-strain loop technique for assessing left ventricular myocardial function in patients undergoing chemotherapy for nasopharyngeal carcinoma

摘要:

目的 应用无创心肌做功超声成像技术评估鼻咽癌患者化疗期间的左心室心肌功能，探讨左心室（LV）压力-应变环（PSL）技术对鼻咽癌化疗患者左心室心肌功能的临床意义。方法 选取赣南医学院第一附属医院收治的28例鼻咽癌化疗患者为鼻咽癌化疗组，分别于接受化疗前（T₀期）、化疗2个周期后（T₁期）、化疗4个周期后（T₂期）行常规超声心动图检查；选取同期健康者24例为对照组，行超声心动图检查。获取两组研究对象的动态二维图像，测定左心室射血分数（LVEF）、左心室收缩末期容积（LVESV）、左心室舒张末期容积（LVEDV）、心输出量（CO）及每搏量（SV）；应用EchoPac软件脱机分析获取左心室整体纵向应变（GLS）、峰值应变离散度（PSD）、整体无用功（GWW）、整体有用功（GCW）、整体做功指数（GWI）和整体做功效率（GWE）等参数，比较两组间及鼻咽癌化疗组3个时期各参数的差异；采用Pearson法分析心肌做功参数与GLS的相关性。结果 研究组T₁期的GLS、GWI与对照组及T₀期相比明显下降（P <0.05）；研究组T₂期的GLS、GWI、GCW、GWE低于对照组及T₀期（P <0.05）；PSD、GWW随化疗周期而显著递增（P <0.05）；GLS与GWI、GCW、GWE呈正相关（r =0.829、0.699和0.739，均P =0.000），与GWW呈负相关（r =-0.502，P =0.000）。结论 GCW、GWI、GWE可以在早期定量测评鼻咽癌化疗患者的心肌损伤情况，相较于LVEF等常规超声心动图参数，LV-PSL技术可更全面地评测心肌收缩功能。

Abstract:

Objective To evaluate the left ventricular myocardial function changes in nasopharyngeal carcinoma (NPC) patients during chemotherapy by noninvasive myocardial work and the clinical evaluation significance of left ventricular pressure-strain loop (PSL) in the effect of nasopharyngeal carcinoma chemotherapy on myocardial work.Methods Twenty-eight patients with nasopharyngeal cancer undergoing chemotherapy in our hospital were selected as the study group, and routine echocardiography was performed before chemotherapy (T₀ stage), 2 cycles of chemotherapy (T₁ stage), and 4 cycles after chemotherapy (T₂ stage). Twenty-four age-matched healthy subjects were selected as the control group. Dynamic two-dimensional images were obtained by echocardiography and conventional echocardiography parameters and image processing were measured. EchoPac software was used for off-line analysis to obtain the global longitudinal strain (GLS), peak strain dispersion (PSD), global wasted work (GWW), global constructive work (GCW), global work index (GWI), and global work efficiency (GWE) of the left ventricle. The differences of parameters between the two groups and the study group in three stages were compared, and statistical analysis was performed.Results Compared with the control group and the study group at T₀ stage, GLS and GWI of the study group at T₁ stage were significantly decreased, and the differences were statistically significan (P < 0.05). GLS, GWI, GCW, and GWE in the study group at T₂ stage were lower than those in the control group and the study group at T₀ stage (P < 0.05). PSD and GWW increased markedly with chemotherapy cycle (P < 0.05). GLS was positively correlated with GWI, GCW, and GWE, and negatively correlated with GWW.Conclusion Parameters such as GCW, GWI, and GWE can quantitatively evaluate the myocardial damage in patients with nasopharyngeal carcinoma undergoing chemotherapy at an early stage. Compared with conventional echocardiography parameters such as left ventricular ejection fraction (LVEF), PSL can more comprehensively evaluate myocardial systolic function.