PCI对射血分数保留冠心病患者左心房-左心室功能耦联的早期影响

Early impact of PCI on left atrial-ventricular functional coupling in coronary heart disease patients with preserved ejection fraction

摘要:

目的 探讨经皮冠状动脉介入治疗（PCI）对左室射血分数（LVEF）保留冠心病患者左心房-左心室功能耦联的早期影响，为临床评估PCI疗效提供超声影像学依据。方法 选取2023年7月—2024年7月安庆市立医院拟行PCI且LVEF≥50%的冠心病患者46例为病例组，另选取同期健康体检者45例为对照组。采用常规超声心动图检测两组研究对象的左心房储备期应变（LASr）、管道期应变（LAScd）、收缩期应变（LASct）、左房僵硬度指数（LASI），以及左心室整体纵向应变（GLS）、整体做功指数（GWI）、整体有效做功（GCW）、整体无效做功（GWW）和整体做功效率（GWE）。比较病例组与对照组上述参数的差异，以及病例组术前、术后3 d、术后1个月的参数变化；采用Pearson法分析病例组术后1个月左心室心肌做功参数与左心房相关参数的相关性。结果 与对照组比较，病例组术前LASr低于对照组，LAScd、LASct、LASI均高于对照组（P <0.05）。与术前及术后3 d比较，术后1个月病例组LASI均降低（P <0.05）。病例组术前GWI、GCW、GWE均低于对照组，GLS、GWW均高于对照组（P <0.05）。与术前比较，术后1个月病例组GWE升高（P <0.05）。与术后3 d比较，术后1个月病例组GLS降低，GWI、GCW、GWE均升高（P <0.05）。Pearson相关性分析结果显示，LASr与GLS、GWW均呈负相关（P <0.05），与GWI、GCW、GWE均呈正相关（P <0.05）；LAScd与GLS、GWW均呈正相关（P <0.05），与GWI、GCW、GWE均呈负相关（P <0.05）；LASct与GLS呈正相关（P <0.05）；LASI与GLS、GWW均呈正相关（P <0.05），与GWI、GCW、GWE均呈负相关（P <0.05）。结论 LVEF保留冠心病患者存在左心房-左心室功能耦联障碍，PCI术后1个月可早期改善其左心室整体做功效率、降低左心房僵硬度，促进左心房-左心室功能耦联良性逆转，左心室整体做功效率可作为评估PCI术后早期心功能恢复的重要指标。

Abstract:

Objective To explore the early effects of percutaneous coronary intervention (PCI) on left atrial-left ventricular functional coupling in patients with coronary heart disease (CHD) and preserved left ventricular ejection fraction (LVEF), and to provide ultrasound imaging evidence for evaluating PCI efficacy.Methods Forty-six CHD patients scheduled for PCI with LVEF ≥ 50% (July 2023-July 2024) were enrolled as the case group, and 45 healthy subjects as the control group. Conventional echocardiography detected left atrial reservoir strain (LASr), conduit strain (LAScd), contractile strain (LASct), stiffness index (LASI), and left ventricular global longitudinal strain (GLS), global work index (GWI), constructive work (GCW), wasted work (GWW), work efficiency (GWE) in both groups. We compared parameter differences between groups and changes in the case group before PCI, 3 days and 1 month after PCI, and analyzed correlations between left ventricular myocardial work and left atrial parameters 1 month after PCI.Results Before PCI, the case group had lower LASr, higher LAScd, LASct and LASI than the control group (all P < 0.05). LASI in the case group decreased significantly 1 month after PCI compared with before PCI and 3 days after PCI (all P < 0.05). Before PCI, GWI, GCW and GWE were lower, while GLS and GWW were higher in the case group than in the control group (all P < 0.05). GWE increased significantly 1 month after PCI compared with before PCI (P < 0.05). Compared with 3 days after PCI, GLS decreased, and GWI, GCW and GWE increased significantly 1 month after PCI (all P < 0.05). Correlation analysis showed that LASr was negatively correlated with GLS and GWW, and positively correlated with GWI, GCW and GWE. LAScd was positively correlated with GLS and GWW, and negatively correlated with GWI, GCW and GWE. LASct was only positively correlated with GLS. LASI was positively correlated with GLS and GWW, and negatively correlated with GWI, GCW and GWE (all P < 0.05).Conclusion Coronary heart disease patients with preserved LVEF have left atrial-left ventricular functional coupling dysfunction. One month after PCI, the overall left ventricular work efficiency can be improved early, left atrial stiffness can be reduced, and the benign reversal of left atrium-left ventricular functional coupling can be promoted. The overall left ventricular work efficiency can serve as an important indicator to evaluate the early recovery of cardiac function after PCI.