应用无创方法评估心衰前期患者心室–动脉 耦联的应用研究

Application of Noninvasive Methods to Assess Ventricular-Arterial Coupling in Patients with Pre-Heart Failure

摘要: 目的：心室动脉耦联(VAC)描述的是心室和动脉系统之间的关系，通常在心力衰竭前期(pre-HF)阶段就已经出现心室动脉解偶联。本研究旨在探讨用左心室整体长轴应变(LVGLS)与估计脉搏波速度(ePWV)的比值来无创评估pre-HF患者的VAC。方法：本研究共招募了133例受试者，将其分为对照组、pre-HF组、射血分数保留的心力衰竭(HFpEF)组和射血分数减低的心力衰竭(HFrEF)组。根据特定公式计算出ePWV，通过二维斑点追踪超声心动图获取LVGLS，用ePWV/LVGLS评估所有受试者的VAC，并分析其与其他传统心功能指标的相关性。结果：pre-HF组的ePWV/LVGLS明显高于HFpEF组和HFrEF组(均P < 0.001)，明显低于对照组(P = 0.016)，且HFpEF组和HFrEF组之间差异显著(P < 0.001)。ePWV/LVGLS与传统心功能指标密切相关。结论：ePWV/LVGLS能够早期筛查pre-HF患者，是无创评估心血管功能的重要临床指标。

Abstract: Objective: Ventricular-arterial coupling (VAC) describes the relationship between the ventricular and arterial systems. Ventricular-arterial uncoupling typically occurs during the pre-heart failure (pre-HF) stage. This study aimed to investigate the use of the ratio of left ventricular global longitudinal strain (LVGLS) to estimated pulse wave velocity (ePWV) for the noninvasive assessment of VAC in patients with pre-HF. Methods: A total of 133 subjects were recruited and divided into a control group, a pre-HF group, a heart failure with preserved ejection fraction (HFpEF) group, and a heart failure with reduced ejection fraction (HFrEF) group. The ePWV was calculated using a specific formula, LVGLS was obtained via two-dimensional speckle-tracking echocardiography, and VAC was assessed for all subjects using ePWV/LVGLS. The correlation between VAC and other traditional cardiac function indices was analyzed. Results: The ePWV/LVGLS ratio in the pre-HF group was significantly higher than that in the HFpEF and HFrEF groups (all P < 0.001) and significantly lower than that in the control group (P = 0.016). Moreover, there was a significant difference between the HFpEF and HFrEF groups (P < 0.001). ePWV/LVGLS was closely correlated with traditional cardiac function indices. Conclusion: ePWV/LVGLS enables early screening of patients with pre-HF and serves as an important clinical indicator for the noninvasive assessment of cardiovascular function.