Correlation between the apical morphology and cardiac function of left ventricular and plaque vulnerability in patients with coronary heart disease
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摘要:
目的探讨冠心病患者左心室心尖形态及功能与斑块易损性的相关性。 方法选取我院2018年1月~2020年1月收治的53例冠心病患者为研究对象，所有患者均行超声心动图及冠状动脉CT造影检查。根据CT造影检测结果分为稳定斑块组（n=28）、易损斑块组（n=25）。比较两组左室收缩末期内径（LVESD）、左室舒张末期内径（LVEDD）、射血分数、心尖部舒张末期左右径（Dap）、心尖球形指数（Siap）、舒张末期心尖角度、收缩末期心尖角度。采用logistics回归分析冠心病患者左心室心尖形态及功能与斑块易损性的相关性。 结果稳定斑块组心功能指标LVEDD、LVESD明显低于易损斑块组（P < 0.05），射血分数明显高于易损斑块组（P < 0.05）；稳定斑块组左心室Dap、舒张末期心尖夹角、收缩末期心尖夹角明显低于易损斑块组（P < 0.05），Siap明显高于易损斑块组（P < 0.05）；斑块易损性是影响左心室Dap、舒张末期心尖夹角、收缩末期心尖夹角、LVEDD、LVESD、射血分数的独立危险因素（P < 0.05）。 结论冠心病患者左室心尖形态及功能和斑块易损性具有显著相关性。 Abstract:ObjectiveTo explore the correlation between the apical morphology and cardiac function of left ventricular and plaque vulnerability in patients with coronary heart disease. Methods53 patients with coronary heart disease in our hospital from January 2018 to January 2020 were enrolled. Echocardiography and coronary CT angiography (CTA) were performed in all patients. According to CTA results, patients were divided into stable plaque group (n=28) and vulnerable plaque group (n= 25). Various indexes were compared between groups, including left ventricular end systolic diameter (LVESD), left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), anterior to posterior diameter (DAP), apical spherical index (Siap), end diastolic apex angle and end systolic apex angle. Correlation between the apical morphology and cardiac function of left ventricular and plaque vulnerability was analyzed using Logistic regression analysis. ResultsLVEDD and LVESD in stable plaque group were significantly lower than those in vulnerable plaque group (P < 0.05), and LVEF was significantly higher than that in vulnerable plaque group (P < 0.05). The left ventricular Dap, end-diastolic apex Angle and endsystolic apex Angle in stable plaque group were significantly lower than those in vulnerable plaque group (P < 0.05), and Siap was significantly higher than that in vulnerable plaque group (P < 0.05). Plaque vulnerability was an independent risk factor affecting left ventricular Dap, end-diastolic apex angle, end-systolic apex angle, LVEDD, LVESD, and LVEF (P < 0.05). ConclusionThe morphology and function of left ventricular apex in patients with coronary heart disease have significant correlation with plaque vulnerability. -
Key words:
- coronary heart disease /
- apical morphology /
- cardiac function /
- plaque vulnerability
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表 1 心功能指标比较
Table 1. Comparison of cardiac function indicators (Mean±SD)
组别 LVEDD（mm） LVESD（mm） LVEF（%） 稳定斑块组（n=28） 50.60±3.52 40.11±2.65 56.77±6.31 易损斑块组（n=25） 54.86±4.28 43.97±3.22 48.03±5.04 t 3.984 4.784 5.257 P < 0.001 < 0.001 < 0.001 LVEDD: 左心室舒张末期内径; LVESD: 左室收缩末期内径; LVEF: 左心室射血分数. 
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表 2 左心室心尖心态比较
Table 2. Comparison of left ventricular apical morphology (Mean±SD)
组别 Dap（mm） Siap 舒张末期心尖夹角（°） 收缩末期心尖夹角（°） 稳定斑块组（n=28） 30.59±2.66 1.35±0.20 74.11±6.34 60.21±5.39 易损斑块组（n=25） 33.98±3.41 1.19±0.13 78.35±7.29 69.51±6.28 t 4.058 3.407 2.246 5.75 P < 0.001 0.001 0.029 < 0.001 Dap: 心尖部舒张末期左右径; Siap: 心尖球形指数.
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表 3 冠心病患者左心室心尖形态及功能与斑块易损性的logistics回归分析
Table 3. Logistic regression analysis of correlation between the apical morphology and cardiac function of left ventricular and plaque vulnerability
影响因素 β SE Wald P OR（95%CI） LVEDD 0.508 0.17 8.931 0.003 1.662（1.249-2.432） LVESD 0.363 0.165 4.86 0.027 1.438（1.160-2.213） LVEF 0.419 0.185 5.14 0.023 1.521（1.310-2.705） Dap 0.524 0.198 7.005 0.008 1.688（1.446-3.140） Siap 0.552 0.197 7.816 0.005 1.736（1.526-3.307） 舒张末期心尖夹角 0.801 0.276 8.395 0.004 2.228（1.730-5.114） 收缩末期心尖夹角 0.893 0.282 10.004 0.002 2.442（1.767-5.343）
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