目的 探讨射血分数保留性心力衰竭（heart failure with preserved ejection fraction,HFpEF）患者左心室功能与脑动脉血流动力学的关系。方法 纳入我院确诊的50例HFpEF患者（HFpEF组）和50例健康志愿者（对照组）。收集两组常规超声心动图参数,应用自动心肌运动定量（automatic cardiac motion quantification,aCMQ）技术获取两组左室射血分数（LVEF）、左室整体长轴应变（LVGLS）及周向应变（LVGCS）,应用经颅彩色双功能超声（TCCS）获取大脑中动脉血流参数：收缩期峰值流速（PSV）、舒张末期流速（EDV）、搏动指数（PI）。比较两组间参数的差异;应用Pearson相关分析法分析左心室功能与大脑中动脉血流参数的相关性;Logistic回归分析发生HFpEF的影响因素。结果 HFpEF组与对照组室间隔舒张末期厚度（IVSD）、左室后壁舒张末期厚度（LVPWD）、二尖瓣环舒张早期峰速（e'）、二尖瓣口舒张早期峰速与二尖瓣环舒张早期峰速之比（E／e'）、左室整体长轴应变（LVGLS）的比较,差异均有统计学意义;HFpEF组E／e'、IVSD、LVPWD均高于对照组,e'、LVGLS绝对值均小于对照组;HFpEF组PI高于对照组;HFpEF组大脑中动脉PI水平与LVGLS水平呈负相关（r=-0.327,P<0.05）,与E／e'水平呈正相关（r=0.281,P<0.05）。Logistic回归分析显示收缩压、LVGLS、PI为HFpEF的独立危险因素,e'为独立保护因素。结论 HFpEF患者左室长轴收缩功能受损,大脑中动脉搏动性增高、僵硬度增加,大脑中动脉僵硬度增加与心肌功能受损存在相关性。
Abstract
Objective To explore the relationship between left ventricular function and cerebral arterial hemodynamics in patients with heart failure with preserved ejection fraction (HFpEF). Methods Fifty patients diagnosed with HFpEF in our hospital (HFpEF group) and fifty healthy volunteers (control group) were enrolled. Conventional echocardiographic parameters of the two groups were collected. Automatic cardiac motion quantification (aCMQ) technology was applied to obtain left ventricular ejection fraction (LVEF), left ventricular global longitudinal strain (LVGLS) and circumferential strain (LVGCS) of the two groups. Transcranial color-coded duplex sonography (TCCS) was used to obtain the blood flow parameters of the middle cerebral artery: peak systolic velocity (PSV), end-diastolic velocity (EDV), and pulsatility index (PI). The differences in parameters between the two groups were compared. Pearson correlation analysis was used to analyze the correlation between left ventricular function and blood flow parameters of the middle cerebral artery; Logistic regression analysis was used to analyze the influencing factors of HFpEF. Results There were significant differences in the interventricular septal end-diastolic thickness (IVSD), left ventricular posterior wall end-diastolic thickness (LVPWD), early diastolic peak velocity of mitral annulus (e'), the ratio of early diastolic peak velocity of mitral orifice to early diastolic peak velocity of mitral annulus (E/e') and LVGLS between HFpEF group and control group. E/e', IVSD and LVPWD in the HFpEF group were higher than those in the control group, e' and the absolute values of LVGLS were lower than those in the control group. The PI in HFpEF group was higher than that in control group. The PI level of middle cerebral artery in HFpEF group was negatively correlated with the absolute values of LVGLS level (r=-0.327, P<0.05), and positively correlated with E/e, level (r=0.281, P<0.05). Logistic regression analysis showed that systolic blood pressure, LVGLS and PI were independent risk factors for HFpEF, and e' was an independent protective factor. Conclusion In HFpEF patients, the left ventricular longitudinal systolic function is impaired, the pulsation and stiffness of the middle cerebral artery are increased. There is a correlation between the increased stiffness of the middle cerebral artery and the impaired myocardial function.
关键词
射血分数保留性心力衰竭 /
自动心肌运动定量 /
长轴应变 /
大脑中动脉
Key words
heart failure with preserved ejection fraction /
automatic cardiac motion quantification /
long axis strain /
middle cerebral artery
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基金
湖南省卫生健康委科研项目“慢性心力衰竭患者脑动脉血流动力学变化及与认知功能相关性研究”（202109021022）; “心脏再同步化治疗对慢性心力衰竭患者左心房结构及功能改变的研究”（202209022886）
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