Evaluation Of Left Ventricular Function By Ultrasonic Pressure-strain Loops Technique In Patients With Heart Failure With Preserved Ejection Fraction

Background: Heart failure is the serious and terminal stage of many cardiovascular diseases.Heart failure with reduced ejection fraction(HFr EF)and heart failure with preserved ejection fraction(HFpEF)were divided according to the left ventricular ejection fraction.Among them,HFpEF accounts for about 50% of all patients with heart failure,and it is more common in the elderly group.With the rapid development of population aging,HFpEF accounts for an increasing proportion in heart failure,which has surpassed HFr EF.Patients with HFpEF had poor quality of life,frequent hospitalization,and no significant difference in prognosis compared with patients with HFr EF.However,the pathophysiological mechanism of HFpEF is still unclear,and there is no effective early diagnosis method and treatment plan at present.Echocardiography is the most commonly used examination technique for heart disease.However,for patients with HFpEF,conventional transthoracic echocardiography can not reflect the early changes of cardiac function in patients with HFpEF because the left ventricular ejection fraction is in normal value.The newly developed non-invasive ultrasonic pressure-strain loop technique can objectively evaluate the global ventricular work by combining two-dimensional speckle tracking technique with afterload measurement,and provides a new method for clinical evaluation of myocardial function.Purpose: In this study,non-invasive ultrasonic pressure-strain ring technique was applied to evaluate the work of left ventricular myocardium in patients with HFpEF,to find out the characteristics of cardiac work in patients with HFpEF,and to provide more basis for early clinical diagnosis and treatment of HFpEF.Method: A total of 43 HFpEF patients admitted to the Department of Cardiology from August to December 2020 were enrolled as the experimental group and 36 normal adults as the control group,with a total of 79 subjects.All subjects were measured height,weight and blood pressure and other clinical data,and statistical HFpEF patients b-type natriuretic peptide(BNP)levels,all application GE Vivid E95 ultrasonic diagnostic instrument,M5S-D phased array probe line of conventional echocardiography,and collecting standard apex four-chamber view,three four-chamber view,two-chamber eager the two-dimensional ultrasound gray-scale ultrasonography import Echo PAC workstation for off-line analysis.Conventional echocardiographic parameters,GLS,PSD,global work index(GWI),global useful work(GCW),global wasted work(GWW)and global work efficiency(GWE)were obtained.Result:(1)GWW of patients with HFpEF was compared with corresponding parameters of the control group.The results showed that GWW increased in patients with HFpEF,and the difference was statistically significant(P<0.05).(2)The GWE and GWI of HFpEF patients were compared with corresponding parameters of the control group.The results showed that the GWE and GWI of patients with HFpEF decreased,and the differences were statistically significant(P<0.05).(3)GCW of patients with HFpEF was compared with corresponding parameters of the control group.The results showed that GCW was slightly reduced in patients with HFpEF,and the difference was not statistically significant(P>0.05).(4)Pearson correlation analysis on HFpEF experimental group showed that GWI,GCW and BNP were linearly negatively correlated,GLS and BNP were linearly positively correlated(P<0.01).(5)ROC was used to evaluate the clinical diagnostic value of cardiac work parameters and GLS in patients with HFpEF.The analysis showed that the area under the curve(AUC)of GWI,GCW,GWW,GWE and GLS were 0.801,0.563,0.969,0.968 and 0.913.The diagnostic value of GWW and GWE in patients with HFpEF was higher than that of GLS,and GWE had the highest diagnostic sensitivity and specificity.Conclusion: 1.Both systolic and diastolic functions of the left ventricle were impaired in patients with HFpEF.2.Compared with the normal population,the HFpEF population did more useless work in the myocardial pumping,and there was no significant difference in the active work.The work index and work efficiency were significantly decreased.3.Noninvasive ultrasonic pressure-strain ring technique can objectively and accurately evaluate the left ventricular work in patients with HFpEF,and predict the potential changes in left ventricular function.Among them,GWE has the highest diagnostic value for HFpEF.