Research progress on normal reference value range and clinical applications of ultrasonic myocardial work parameters
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摘要: 心肌做功（MW）技术通过结合二维斑点追踪超声心动图与无创肱动脉血压得到左室压力应变环，产生四个主要的参数评价心肌收缩功能。相比于目前临床上广泛应用的左室射血分数，MW在应变基础上具有更好地减少负荷对心肌功能评估的影响、提供整体与局部心肌功能信息和早期识别心血管疾病心肌功能受损情况等特点。本文首先介绍了MW原理及主要参数，归纳不同人群中MW参数正常参考值范围研究结果，对MW应用于临床心血管疾病心肌收缩功能评价的代表性研究成果做出综述，最后分析了MW的局限性，并对该技术良好的应用前景作出展望。Abstract: Myocardial work (MW) technology obtains the left ventricular pressure-strain loop by combining two-dimensional speckle tracking echocardiography with noninvasive brachial artery blood pressure, and produces four main parameters to evaluate myocardial systolic function. Compared with the left ventricular ejection fraction, which is widely used in clinic at present, MW has the characteristics of better reducing the impact of load on the evaluation of myocardial function on the basis of strain, providing global and segmental myocardial function information, and early identifying the damage of myocardial function in cardiovascular diseases. This paper first introduces the principle and main parameters of MW, summarizes the research results of the normal reference value range of MW parameters in different populations, then the representative research results of MW applied to the evaluation of myocardial systolic function in clinical cardiovascular diseases are summarized, and finally analyzes the limitations of MW, as well as prospects the good application prospect of MW technology.
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表 1 不同健康人群中对MW参数正常值范围
Table 1. Normal value range of MW parameters in different healthy populations.
研究者及年份 研究人群 人群来源 样本量（n） 男性（%） 年龄（岁） 性别/总人群 MW主要参数 研究差异（性别和年龄） GWI（mmHg%） GCW（mmHg%） GWW（mmHg%） GWE（%） Manganaro[23] (2019) 欧洲受试者≥25岁 由欧洲心血管影像协会（EACVI）招募 226 37.6 45±13 总 1896±308 2232±331 78.5 (53~122.2) 96 (94~97) 男性相比于女性有显着较低的GWE值和较高的GWW值。同时认为女性的GWI和GCW随着年龄的增长而显着增加。 男 1849 ± 295 2228± 295 94 (61.5~130.5) 95 (94~97) 女 1924±313 2234 ± 352 74 (49.5~111) 96 (94~97) Galli[22] ≥18岁 Rennes university hospital健康队列的受试者 115 67 36.3(18~69) 总 1926±247 2224±229 61~123 94~97 女性的GWI、GCW显著高于男性（P>0.05）。4个MW主要参数与年龄没有相关性。 男 1874±232 2194±207 91 (95% CI：61~123) 96 (94~97) 女 2031±247 2289±261 87 (95% CI：60~122) 96 (94~97) Morbach[29](2020) 德国维尔茨堡市的人口年龄在30~79岁之间的人群 心力衰竭A/B阶段的特征和病程以及进展的决定因素（STAAB）队列人群 779 41 49±10 总 2209 ± 307 2430±351 74 (95% CI：54~101) 96(95~97) 在45岁之前，GCW、GWW和GWE水平与性别无关。当年龄>45岁，GWI和GWE随年龄增长而增加，且女性GWI高于男性。 Truong[31] (2021) >18岁 13项数据集的健康受试者（Meta分析） 1665 38 年龄范围：20~53 总 2010 (95% CI：1907-2113) 2278 (95% CI：2186-2369) 80 (95% CI：73~87) 96 (95% CI：96~96) GWI和GWW与性别有相关性，而GWE与年龄和性别都相关（P＜0.05）。 Olsen[30] (2022) 哥本哈根市心脏研究（CCHS）的健康人群 哥本哈根市心脏研究（CCHS） 1827 39 中位年龄：45 总 2118 (95% CI：1576-2661) 2262 (95% CI：1708-2816) 64 (95% CI：22~159) 97.1 (93.0~99.0) 对于男性，只有GCW随年龄增加，而其他参数不随年龄变化。对于女性而言，GCW随年龄增长呈线性增加，而GWI、GWW和GWE随年龄呈曲线变化。因此年轻参与者的GWI增加，老年参与者的GWW增加，GWE一致下降。 男 2062 (95% CI：1534-2590) 2229 (95% CI：1690-2767) 60 (95% CI：20~153) 97.2 (95% CI：93.2~99.1) 女 2155 (95% CI：1615-2694) 2283 (95% CI：1723-2843) 68 (95% CI：24~168) 97.0 (95% CI：92.9~98.9) Tretter[24] (2021) 青少年 Cincinnati Children's Hospital Medical Center 52 62 14.5±2.0 总 1802.0±264.4 2054.5±297.3 83.8±28.1 95.5±1.1 多变量分析中，MW的各个参数（GWI、GCW、GWW、GWE）与年龄、性别都没有相关性（P>0.05）。 男 1776.8 ± 262.7 2024.0 ± 283.5 82.7± 26.9 95.6± 1.1 女 1842.2 ± 268.9 2103.4 ± 319.5 85.6 ± 30.4 95.4 ± 1.1 Sabatino[27] (2022) 儿童与青少年 涉及三个儿科实验室的多中心研究 150 61 10.6±4.5 总 1760±228 2141(95% CI：2115~2204) 69(95% CI：68~80) 96 (95.9~96.3) MW的各个参数（GWI、GCW、GWW、GWE）与年龄、性别都没有相关性（P>0.05）。 男 1767±212 2159 (95% CI：2089~2201) 63 (95% CI：63~78) 96 (95.9~96.5) 女 1748± 252 2111(95% CI：2106~2259) 71 (95% CI：70~90) 96 (95.5~96.3) Pham[25] (2021) 儿童 Tam Duc Heart Hospital 212 47 9(6~12) 总 1688±219 1959±207 61.1±30.9 96.5±1.4 不同年龄组和性别与MW指数差异无统计学意义（P>0.05）。 男 1699 ± 211 1961 ± 206 60.4 ± 31.9 96.5 ± 1.4 女 1679 ± 226 1958 ± 210 61.6 ± 30.1 96.4 ± 1.4 Cui[32] (2022) 儿童 中国医学科学院阜外医院 183 52.5 10(6~13) 总 1448.7±265.0 1859.8±290.7 54.0(95% CI：33.0~82.0) 97.0 (95.0~99.0) 男性GWI、GCW均高于女性（P＜0.01），GWW与GWE在性别中差异无统计学意义。4个MW主要参数与年龄密切相关，且呈现不同的趋势（P＜0.05）。经体表面积调整过的GWI（体表面积）与GCW（体表面积）与年龄负相关（P＜0.001）。 Cui[20]（2022） 1~18岁 183 52.5 男 1572.5±250.2 1944.3±299.2 55.0(95% CI：35.3~83.8) 97.0 (95.0~98.0) 女 1312.2±208.7 1766.6±251.5 51.0(95% CI：32.0~79.0) 96.0 (95.0~98.0) 林静茹[28] (2020) ≥18岁 中国医学科学院阜外医院 64 48.4 51±14 总 2014±245 2273±287 99(95% CI：70~121) 95(94~96) 男性静息状态GWW值大于女性，GWI、GCW和GWE值小于女性，但差异均无统计学意义（P>0.05）。GWI、GCW和GWW值随着年龄增长有升高趋势，但差异均无统计学意义（P>0.05）；≥60岁GWE值低于18~44岁和45~59岁，但差异均无统计学意义（P>0.05）。 男 1998±225 2241±235 102(95% CI：86~132) 94(93~96) 女 2029±266 2302±330 91(95% CI：69~119) 95(94~96) 丁雪晏[26] (2021) ≥18岁 首都医科大学附属北京朝阳医院 64 48.4 52.1±10.7 总 2065±298 2255±302 89(56.5~112.5) 96(95~97) 女性GWI及GCW均高于男性（均有P＜0.05），GWW、GWE性别差异无统计学意义(P>0.05)。GWI、GCW、GWW及GWE与年龄无相关性（均有P>0.05）。 男 1952±232 2137±216 85.5(55.8~101) 96(95~97) 女 2168±336 2361±349 96±46 95(94~97) 
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