Application Research Of Left Ventricular Pressure-strain Loop In Evaluating Myocardial Work In Patients With Hypertrophic Cardiomyopathy

ObjectiveNon-invasive left ventricular pressure-strain loop(PSL)technique was used to quantitatively analyze left ventricular myocardial work in patients with hypertrophic cardiomyopathy(HCM),and to explore its value in evaluating the changes of left ventricular myocardial function in patients with HCM.Methods46 patients with HCM(54.3% male with age of 51.41±16.82)who were diagnosed in the department of cardiovascular medicine or ultrasound medicine in our hospital from December 2020 to January 2022 were divided into non-obstructive hypertrophic cardiomyopathy(NHCM)group(n=21)and obstructive hypertrophic cardiomyopathy(HOCM)group(n=25).At the same time,another 27 healthy subjects with matched age and sex were selected as the control group.Standard echocardiographic images of all subjects were collected,and conventional echocardiographic parameters such as left atrial diameter(LAD),maximum left ventricular wall thickness(MWT),left ventricular end-diastolic diameter(LVEDd),left ventricular end-systolic diameter(LVESd),left ventricular outflow tract pressure gradient(LVOTPG)and left ventricular ejection fraction(LVEF)were obtained.Non-invasive PSL constructed by twodimensional speckle tracking echocardiography was used to obtain strain and myocardial work parameters such as global longitudinal strain(GLS),global work index(GWI),global work efficiency(GWE),global constructive work(GCW)and global waste work(GWW).The differences of the above parameters among the three groups were compared and analyzed.And correlation analysis was carried out.ResultsThe comparison of general data showed that there no significant differences in age,height,weight,body mass index,body surface area,heart rate,systolic blood pressure and diastolic blood pressure among the three groups(P > 0.05).The comparison of parameters of conventional echocardiography: compared with the control group,LAD,MWT,IVST,LVPWT,LVOTPG and E/e’increased in NHCM group and HOCM group,while LVESd,LVEDd and E/A decreased(P < 0.05).Compared with NHCM patients,LAD,MWT,IVST,LVPWT,LVOTPG and average E/e’increased more significantly in HOCM(P < 0.05).There were no significant differences in LVEF,E peak and A peak among the three groups(P > 0.05).The comparison of strain and myocardial work parameters: the average GWE,GWI,GCW and GLS of HCM patients were significantly lower than those of the control group,while GWW were increased(P < 0.05).Compared with NHCM group,GWI GCW and GLS were decreased in patients with HOCM(P < 0.05),but there was no significant difference in GWW and GWE(P > 0.05).Correlation analysis shows that GLS was positively correlated with GWI,GCW and GWE,but negatively correlated with GWW,LVOTPG and MWT(P < 0.05).GCW was negatively correlated with LAD,E/e’,LVOTPG,MWT(P < 0.05).LVOTPG was positively correlated with E/e’ and LAD(P < 0.05).Conclusion1.Although LVFE was retained in HCM patients,GWI,GCW,GWE and GLS were significantly decreased and GWW was significantly increased.Compared with NHCM patients,GWI,GCW and GLS decreased more significantly in HOCM patients.PSL was more sensitive than LVEF in evaluating left ventricular myocardial function in HCM patients.2.PSL technique can objectively evaluate left ventricular myocardial work in patients with HCM and detect left ventricular systolic dysfunction in patients with HCM as early as possible,which provides an important reference for clinical diagnosis and treatment.