Evaluation of left ventricular work in patients with different rheumatic immunological diseases using pressure strain loop technique
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摘要:
目的 应用压力-应变环技术评估不同风湿免疫病患者的左心室做功状况。 方法 前瞻性选择于2021年4月~2022年11月于扬州大学附属医院确诊的风湿免疫病患者171例，按照疾病类别分为系统性红斑狼疮组30例、强直性脊柱炎组33例、干燥综合征组35例、类风湿关节炎组43例、痛风组30例，病程均≤5年；另选取同期健体检者32例为对照组。所有参与者均行常规超声心动图采集图像, 线下ECHOPAC分析得出压力-应变环参数；分析各组之间常规参数及心肌做功之间的相关性，评估左室心肌做功状况。 结果 与对照组相比，风湿免疫疾病组的A值均增高、E/A比值均降低（P < 0.05）；系统性红斑狼疮组及干燥综合征组的E值降低，差异有统计学意义（P < 0.05）。所有风湿免疫疾病组的整体无效做功高于对照组，整体做功效率低于对照组（P < 0.05）；系统性红斑狼疮组及强直性脊柱炎组的整体纵向应变、整体做功指数、整体有效做功低于对照组，类风湿关节炎组的整体纵向应变、整体做功指数低于对照组，痛风组的整体做功指数低于对照组，差异有统计学意义（P < 0.05）。风湿免疫疾病组的整体纵向应变绝对值、左室射血分数、E/A比值与整体做功指数、整体有效做功、整体做功效率之间呈正相关关系，与整体无效做功呈负相关关系（P < 0.01）。 结论 压力-应变环能够有效评估风湿免疫病患者左心室心肌做功状况, 将更客观的为临床提供新的诊断依据。 Abstract:Objective To evaluate left ventricular work in patients with different rheumatic immune diseases using pressure-strain loop technique. Methods We prospectively selected 171 patients with rheumatic immune diseases diagnosed in the Affiliated Hospital of Yangzhou University from April 2021 to November 2022. The patients were divided into systemic lupus erythematosus group (n=30), ankylosing spondylitis group (n=33), Sjogren's syndrome group (n=35), rheumatoid arthritis group (n=43) and gout group (n=30). The course of disease was ≤ 5 years. Another 32 cases of physical examination during the same period were selected as the control group. All participants underwent conventional echocardiography to collect images, and obtained pressure strain loop parameters through offline ECHOPAC analysis. Statistical analysis of the correlation between routine parameters and myocardial work among groups was conducted to assess the left ventricular myocardial work status. Results Compared with the control group, the A peak of rheumatic immune disease groups increased and the E/A ratio decreased (P < 0.05). The E peak of systemic lupus erythematosus group and Sjogren's syndrome group decreased significantly (P < 0.05).The global wasted work of all rheumatic immune disease groups was higher, and the global work efficiency was lower (P < 0.05). The global longitudinal strain, global work index, and global constructive work in the systemic lupus erythematosus group and ankylosing spondylitis group and the global longitudinal strain, global work index, and global constructive work in the rheumatoid arthritis group and the global work index in the gout group were all decreased, with a statistically significant difference (P < 0.05). The absolute value of global longitudinal strain, left ventricular ejection fraction, and E/A ratio in the rheumatic immune disease group were positively correlated with global work index, global constructive work, and global work efficiency, while they were negatively correlated with global wasted work (P < 0.01). Conclusion The pressure strain loop can effectively assess the left ventricular myocardial work status in patients with rheumatic immune disease.It will objectively provide a more objective new diagnostic basis for clinical practice. -
图 1 不同风湿免疫组的PSL参数的比较
Figure 1. PSL parameters comparison of different rheumatic immune disease groups. A: Control group (normal physical examination, female, 47 years old); B: Systemic lupus erythematosus group (female, 45 years old, disease duration: 4 years); C: Sjogren's syndrome group (female, 48 years old, disease duration: 3 years and 5 months); D: Ankylosing spondylitis group (male, 46 years old, disease duration: 4 years and 2 months); E: Gout patient group (male, 52 years, disease duration : 4 years); F: Rheumatoid arthritis group (female, 48 years old, disease duration: 3 years). Compared with the control group, GWW of all rheumatic immune groups increased, GWE decreased, and PSL area decreased.
表 1 风湿病组与对照组的一般资料比较
Table 1. Comparison of general clinical data between rheumatic group and control group (Mean±SD)
Characteristic Male/Female(n) Age (year) Systolic pressure (mmHg) Diastolic pressure (mmHg) Rheumatology group（n=171） Systemic lupus erythematosus group（n=30） 1/29 45.2±15.1 114.2±8.37 76.3±4.9 Sjogren's syndrome group（n=35） 5/30 47.4±11.34 115.6±7.2 76.8±3.8 Ankylosing spondylitis group（n=33） 25/8 44.4±14.2 116.2±7.8 76.0±6.1 Rheumatoid arthritis group（n=43） 4/39 51.6±10.2 116.6±8.8 77.0±6.3 Gout group（n=30） 28/2 50.1±10.4 113.1±6.2 75.6±4.5 Control group（n=32） 5/27 46.5±12.2 113.6±6.6 75.9±4.5 F - 2.216 1.354 0.437 P - 0.054 0.243 0.822 
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表 2 风湿病组与对照组常规超声心动图参数比较
Table 2. Comparison of routine echocardiographic parameters between rheumatic group and control group (Mean±SD)
Characteristic Diastolic interventricular septal thickness（mm） Left ventricular end-diastolic diameter（mm） Left ventricular end-systole diameter（mm） Ejection fraction（%） Fractional shortening（%） E peak（cm/s） A peak（cm/s） E/A ratio Rheumatology group(n=171) Systemic lupus erythematosus group（n=30） 8.3±1.5 48.5±3.3 29.4±3.0 69.1±5.6 38.4±3.6 58.6±1.7* 74.5±14.5* 0.8±0.2* Sjogren's syndrome group（n=35） 7.6±1.3 48.2±2.6 29.0±2.1 69.5±5.1 39.1±4.3 64.4±14.0* 72.0±17.1* 0.9±0.3* Ankylosing spondylitis group（n=33） 8.4±1.3 49.1±2.5 30.5±2.1 67.5±4.0 39.8±3.4 65.4±16.6 71.0±14.5* 1.0±0.5* Rheumatoid arthritis group（n=43） 7.7±1.3 48.5±3.0 29.5±2.5 68.3±4.1 38.4±3.4 66.6±14.5 71.3±15.9* 0.9±0.2* Gout group（n=30） 7.9±1.4 49.1±2.5 29.7±1.9 68.2±3.8 38.5±3.6 67.2±14.8 70.0±15.8* 1.0±0.3* Control group（n=32） 8.0±1.4 49.2±3.0 29.6±2.5 68.6±4.5 38.8±3.7 72.4±14.4 61.0±14.0 1.2±0.3 t 2.020 1.900 1.399 0.944 0.669 2.948 2.972 5.672 P 0.077 0.096 0.226 0.453 0.647 0.014 0.013 < 0.001 *P < 0.05 vs control group. E peak: early diastolic peak velocity of mitral valve orifice; A peak: late diastolic peak velocity of mitral valve orifice; E/A: The ratio of early diastolic peak flow velocity to late diastolic peak flow velocity of the mitral valve.
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表 3 风湿病组与对照组的左心室PSL参数比较
Table 3. Comparison of left ventricular PSL parameters between rheumatic group and control group (Mean±SD)
Characte GLS(%) GW(mmHg%) GCW(mmHg%) GWW(mmH GWE(%) Rheumatology group（n=171） Systemic lupus erythematosus group（n=30） -17.5±1.6* 1542.5±168.8* 1916.1±145.3* 115.7±53.7* 93.2±2.8* Sjogren's syndrome group（n=35） -18.4±1.7 1656.6±173.2 2026.5±180.7 116.4±49.5* 93.5±2.1* Ankylosing spondylitis group（n=33） -17.5±1.8* 1553.4±197.3* 1908.5±194.6* 116.7±60.0* 93.4±3.1* Rheumatoid arthritis group（n=43） -17.7±1.5* 1586.8±160.6* 2000.4±225.0 137.1±61.1* 92.6±2.5* Gout group（n=30） -18.1±1.6 1595.8±165.6* 1983.8±184.9 130.5±70.1* 91.6±7.7* Control group（n=32） -18.6±1.2 1833.31±196.14 2006.0±170.3 60.96±16.65 95.6±1.6 t1 3.065 3.098 2.228 3.780 4.079 P1 < 0.05 < 0.05 < 0.05 < 0.05 < 0.05 t2 0.469 0.559 0.478 4.161 4.397 P2 0.641 0.578 0.635 < 0.05 < 0.05 t3 2.756 2.706 2.146 3.580 3.489 P3 < 0.05 < 0.05 < 0.05 < 0.05 < 0.05 t4 2.900 2.370 0.118 5.343 5.728 P4 < 0.05 < 0.05 0.907 < 0.05 < 0.05 t5 1.552 2.003 0.508 4.180 2.832 P5 0.125 < 0.05 0.613 < 0.05 < 0.05 *P<0.05 vs Control group. t1, P1: Systemic lupus erythematosus group vs Control group; t2, P2: Sjogren's syndrome group vs Control group; t3, P3: Ankylosing spondylitis group vs Control group; t4, P4: Rheumatoid arthritis group vs Control group; t5, P5: Gout group vs Control group; GLS: Global longitudinal strain; GWI: Global work index; GCW: Global constructive work; GWW: Global wasted work; GWE: Global work efficiency.
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表 4 相关性分析
Table 4. Correlation analysis
Characteristic GWI GCW GWW GWE r P r P r P r P GLS absolute value 0.713 < 0.01 0.585 < 0.01 -0.450 < 0.01 0.350 < 0.01 Ejection fraction 0.809 < 0.01 0.550 < 0.01 -0.345 < 0.01 0.278 < 0.01 E/A ratio 0.381 < 0.01 0.341 < 0.01 -0.290 < 0.01 0.247 < 0.01
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表 5 重复性检验结果
Table 5. Repeatability test results
Characteristic Intra physician Inter physician ICC 95% CI ICC 95% CI GLS 0.981 0.945-0.994 0.890 0.705-0.962 GWI 0.928 0.800-0.975 0.884 0.690-0.959 GCW 0.954 0.869-0.984 0.962 0.795-0.975 GWW 0.989 0.967-0.996 0.971 0.916-0.990 GWE 0.958 0.879-0.986 0.947 0.850-0.982 ICC: Intraclass correlation coefficient.
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