肥厚型心肌病超声心肌做功参数变化及预测心血管事件的价值

肥厚型心肌病超声心肌做功参数变化及预测心血管事件的价值
侯苏芸，滑少华，崔可飞，孙梦娇，李莉锦，王红鹄
郑州大学第一附属医院超声科，河南郑州450015
【摘要】目的观察肥厚型心肌病(HCM)超声心肌做功参数的变化，并探讨其预测患者心血管事件的价值。

方法
前瞻性选取2019年1月至2022年4月郑州大学第一附属医院收治的176例HCM 患者纳入研究，每3~6个月
随访1次，随访12个月，根据患者随访期间(排除4例失访病例)是否发生心血管事件分为事件组(发生心血管事件)46例和对照组(未发生心血管事件)126例，比较两组患者的常规超声心动图参数[左心室舒张末期容积(LVEDV)、左心房容积指数(LA VI)、左心室收缩末期容积(LVESV)、左心房内径指数(LADI)、标准化体表面积(BSA)、左心房容积(LA V)、左心室射血分数(LVEF)、左心房内径(LAD)]及超声心肌做功参数[有效做功(GCW)、心肌做功效率(GWE)、无效做功(GWW)、心肌整体做功指数(GWI)]变化，采用受试者工作特征曲线(ROC)分析超声心肌做功参数对HCM 患者心血管事件的预测价值，并采用相对危险度(RR)分析心肌做功参数与心血管事件发生的关系。

结果
事件组中
29例(63.07%)发生心房颤动，3例(6.52%)发生室性心动过速，4例(8.70%)发生晕厥，8例(17.39%)发生心绞痛，2例(4.35%)发生充血性心力衰竭。

就诊时、随访6个月、随访12个月，事件组患者的LADI 、LA V 、LAD 、LA VI 明显高于对照组，差异均有统计学意义(P <0.05)；就诊时、随访6个月、随访12个月，事件组患者的GWI 、GCW 、GWE 明显低于对照组，GWW 明显高于对照组，差异均有统计学意义(P <0.05)；经ROC 分析结果显示，就诊时和随访6个月时，各项做功参数联合预测HCM 患者心血管事件的曲线下面积(AUC)为0.922(敏感度80.43%，特异度88.89%)、0.943(敏感度89.13%，特异度89.68%)，均大于GWI 、GCW 、GWW 、GWE 单独预测AUC (P <0.05)；经HCM 患者心血管事件发生危险度分析，就诊时，GWI 、GCW 、GWW 、GWE 所致RR 分别为10.400、13.450、0.105、5.716，差异均有统计学意义(P <0.05)，随访6个月时，GWI 、GCW 、GWW 、GWE 所致RR 分别为10.021、11.241、0.086、7.987，差异均有统计学意义(P <0.05)。

结论
发生心血管事件的HCM 患者超声心肌做功参数存在明显变化，GWI 、GCW 、GWW 、GWE
对HCM 患者心血管事件发生有较高预测价值，可作为评估其心血管事件风险的有效指标。

【关键词】肥厚型心肌病；心肌做功；超声；心血管事件；预测价值【中图分类号】R542.2
【文献标识码】A
【文章编号】1003—6350（2024）02—0252—06
Changes of ultrasonic myocardial work parameters in hypertrophic cardiomyopathy and their value in predicting cardiovascular events.HOU Su-yun,HUA Shao-hua,CUI Ke-fei,SUN Meng-jiao,LI Li-jin,WANG Hong-hu.Department of Ultrasound,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450015,Henan,CHINA
【Abstract 】Objective
To observe the changes of ultrasonic myocardial work parameters in hypertrophic car-diomyopathy (HCM)and explore its value in predicting cardiovascular events in patients.Methods A total of 176pa-tients with HCM admitted to the First Affiliated Hospital of Zhengzhou University from January 2019to April 2022were prospectively selected and included in the study.The patients were followed up every 3-6months,for 12months.According to whether cardiovascular events occurred during the follow-up period (excluding 4cases lost in follow-up),they were divided into an event group (46cases with cardiovascular events)and a control group (126cases without car-diovascular events).The changes of routine echocardiographic parameters [left ventricular end-diastolic volume (LVEDV),left atrial volume index (LA VI),left ventricular end-systolic volume (LVESV),left atrial diameter index (LADI),standardized body surface area (BSA),left atrial volume (LA V),left ventricular ejection fraction (LVEF),left atrial diameter (LAD)]and ultrasonic myocardial work parameters [global constructive work (GCW),global work effi-ciency (GWE),global wasted work (GWW),myocardial global work index (GWI)]were compared between the two groups.Receiver operating characteristic (ROC)curve was used to analyze the predictive value of ultrasonic myocardial work parameters for cardiovascular events in HCM patients,and the relationship between myocardial work parameters and cardiovascular events was analyzed using relative risk (RR).Results
In the event group,they were 29cases
(63.07%)of atrial fibrillation,3cases (6.52%)of ventricular tachycardia,4cases (8.70%)of syncope,8cases (17.39%)of angina pectoris,and 2cases (4.35%)of congestive heart failure.The LADI,LA V ,LAD,and LA VI of patients in the event group were significantly higher than those in the control group at the time of visit,follow-up for 6months,
·论著·
doi:10.3969/j.issn.1003-6350.2024.02.021
基金项目：2020年河南省医学科技攻关计划联合共建项目(编号：LHGJ20201057)。

第一作者：侯苏芸(1982—)，女，副主任医师，硕士，主要从事心脏心肌病变及瓣膜病变的超声检查工作。

通讯作者：滑少华(1970—)，女，主任医师，博士，主要从事先天性心脏病及心肌、心瓣膜病变的超声检查工作，E-mail：***************。

肥厚型心肌病(hypertrophic cardiomyopathy，HCM)是遗传性心肌病，临床研究表明HCM患者心肌功能在早期无明显临床症状时已受到影响[1-3]。

心肌收缩、舒张功能障碍引起心房颤动、心律失常等发生风险较高。

超声心动图可通过常规心室参数评估HCM患者心脏结构、瓣膜形态、血流速度等，但对于早期心肌收缩功能改变不易检出[4-5]。

左室压力-应变环是在二维斑点追踪技术基础上结合心肌形变与左室压力，是无创性定量评估心肌做功的新手段[6]。

目前临床尚缺乏超声心肌做功参数在HCM患者心血管事件评估中的应用研究。

本研究尝试采用超声心肌做功参数对HCM患者心血管事件进行预测，以期为临床及时干预、减少HCM患者不良预后提供参考。

1资料与方法
1.1一般资料经我院医学伦理委员会批准，前瞻性选取2019年1月至2022年4月郑州大学第一附属医院收治的176例HCM患者纳入研究。

纳入标准：(1)经过超声心动图检查，室间隔厚度≥15mm；(2)符合《中国成人肥厚型心肌病诊断与治疗指南》中的标准[7]；(3)三支冠脉狭窄程度≤50%；(4)能接受门诊随访；(5)左室射血分数(LVEF)＞50%；(6)窦性心律；(7)心功能纽约心脏病协会(NYHA)分级Ⅰ~Ⅱ级。

排除标准：(1)既往有心脏手术史；(2)继发性左室肥厚；(3)有其他类型心肌病；(4)永久或持续性心房颤动；(5)左心室流出道梗阻；(6)存在肝肾等器质性病变；(7)存在心脏瓣膜疾病；(8)已出现心力衰竭表现；(9)有起搏器植入史；(10)精神异常。

HCM患者中男性113例，女性63例；年龄31~57岁，平均(4
2.16±5.57)岁；心尖肥厚28例，室间隔/左室后壁≥15mm148例；对称性肥厚18例，不对称性肥厚158例；梗阻性96例，非梗阻性80例；NYHA分级Ⅰ级67例，Ⅱ级109例。

1.2方法(1)超声心动图检查：采用彩色多普勒显像仪(美国GE公司，型号：Vivid7)，探头频率：
2.5~
3.5MHz，按常规方法检查，二维超声测量LVEF、左心房内径(LAD)、计算左心室舒张末期容积(LVEDV)、左心房容积指数(LA VI)、左心室收缩末期容积(LVESV)、左心房内径指数(LADI)、左心房容积(LA V)、标准化体表面积(BSA)。

采集主动脉瓣及二尖瓣前向血流频谱，将图像拷出脱机处理。

(2)心肌做功参数分析：选择血流频谱，采用AFI分析模式依次分析心尖四腔心、两腔心切面，建立左室压力-应变环，系统自动获得心肌做功参数，包括有效做功(GCW)、心肌做功效率(GWE)、无效做功(GWW)、心肌整体做功指数(GWI)。

1.3观察指标(1)统计随访结果及心血管事件发生情况；(2)比较两组患者就诊时、随访6个月、随访12个月的常规超声心动图参数；(3)比较就诊时、随访6个月、随访12个月两组患者的超声心肌做功参数；(4)分析就诊时、随访6个月超声心肌做功参数对HCM患者心血管事件的预测价值；(5)分析就诊时、随访6个月超声心肌做功参数与HCM患者心血管事件发生的关系。

1.4统计学方法应用SPSS23.0统计软件分析数据。

计量资料以均数±标准差(x
-±s)表示，两两比较采用t检验，计数资料比较采用χ2检验；绘制受试者工作特征曲线(ROC)评估超声心肌做功参数对HCM患者心血管事件的预测价值，采用相对危险度(RR)分析超声心肌做功参数与HCM患者心血管事件发生的关系。

以P<0.05表示差异有统计学意义。

2结果
2.1随访结果及心血管事件发生情况自患者就诊于本院并确诊HCM开始随访，以门诊方式随访
and follow-up for12months,and the differences were statistically significant(P<0.05).At the time of visit,follow-up for6months,and follow-up for12months,the GWI,GCW,and GWE of patients in the event group were significantly lower than those in the control group,while the GWW was significantly higher than that in the control group,with statis-tically significant differences(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of the com-bined detection of various work parameters for predicting cardiovascular events in HCM patients at the time of visit and 6months of follow-up was0.922(sensitivity80.43%,specificity88.89%),0.943(sensitivity89.13%,specificity 89.68%),both of which were greater than the AUC of GWI,GCW,GWW,and GWE alone(P<0.05).The analysis of the risk of cardiovascular events in patients with HCM showed that the RR caused by GWI,GCW,GWW,and GWE at the time of visit were10.400,13.450,0.105,and5.716,respectively,and the differences were statistically significant(P< 0.05).The RR caused by GWI,GCW,GWW,and GWE at6months of follow-up were10.021,11.241,0.086,and7.987, respectively,and the differences were statistically significant(P<0.05).Conclusion There were significant changes in ultrasonic myocardial work parameters in HCM patients with cardiovascular events.GWI,GCW,GWW,and GWE have high predictive value for cardiovascular events in HCM patients,which can be used as effective indicators to assess the risk of cardiovascular events.
【Key words】Hypertrophic cardiomyopathy;Myocardial work;Ultrasound;Cardiovascular events;Predictive value
12个月，176例患者中失访4例(2例复诊意识不强失访，1例住址变更失访，1例外出失访)，随访期间172例患者中有46例发生心血管事件，计为事件组，包括心房颤动29例(63.04%)、室性心动过速3例(6.52%)、晕厥4例(8.70%)、心绞痛8例(17.39%)、充血性心力衰竭2例(4.35%)；126例未发生心血管事件计为对照组。

2.2两组患者的常规超声心动图参数比较就
诊时、随访6个月、随访12个月，事件组患者的LADI 、LA V 、LAD 、LA VI 明显高于对照组，差异均有统计学意义(P <0.05)，但两组患者的LVEDV 、LVESV 、LVEF 、BSA 比较差异均无统计学意义(P >0.05)，见表1。

表1
两组患者的常规超声心动图参数比较(x -±s )
Table 1
Comparison of conventional echocardiographic parameters between two groups of patients (x -±s )时间就诊时
随访6个月
随访12个月组别事件组对照组t 值P 值
事件组对照组t 值P 值
事件组
对照组t 值P 值
LVEDV (mL)73.80±17.0775.31±16.720.5210.60374.65±17.3176.85±16.680.7580.4576.38±16.9478.37±16.370.6990.485
LVESV (mL)25.84±5.7326.79±6.070.9220.35826.64±6.1827.21±6.340.5250.626.95±6.3728.73±7.511.430.155
注：与就诊时比较，a P <0.05，与随访6个月比较，b
P <0.05。

Note:Compared with that at the time of the visit,a P <0.05,and compared with that at 6months of follow-up,b P <0.05.
LADI (cm/m 2)4.54±0.114.12±0.0925.4760.0014.24±0.09a 4.10±0.06a
11.7410.0014.00±0.12ab 3.93±0.10ab 3.8460.001
LA VI (mL/m 2)64.66±15.3849.73±14.595.8550.00158.44±7.64a
49.68±4.103.7040.00153.07±12.52ab 49.17±9.842.1330.034
LAD (cm)4.27±0.643.83±0.474.9080.0013.94±0.58a
3.77±0.402.1710.031
3.68±0.49ab 3.54±0.35ab 2.0730.04
LA V (mL)60.78±15.6346.25±14.015.8350.001
54.35±14.96a 45.71±13.463.6150.001
48.82±14.33ab 44.25±11.432.1630.032
LVEF (%)61.71±4.4362.24±4.960.6380.525
62.37±4.5863.24±4.751.0730.285
62.81±4.7363.85±5.171.1940.234
BSA (m 2)
0.94±0.120.93±0.100.5490.584
0.93±0.150.92±0.130.4280.669
0.92±0.180.90±0.170.6720.502
例数46126
46126
461262.3两组患者的超声心肌做功参数比较就诊时、随访6个月、随访12个月，事件组患者的GWI 、GCW 、GWE 明显低于对照组，GWW 明显高于对照组，差异均具有统计学意义(P <0.05)，见表2、图1和图2。

2.4超声心肌做功参数对HCM 患者心血管事件的预测价值以事件组为阳性样本，对照组为阴性样本，绘制就诊时、随访6个月GWI 、GCW 、GWW 、GWE 预测HCM 患者心血管事件的ROC 曲线，结果显示，就诊时、随访6个月各项做功参数联合预测的AUC 为
0.922、0.943，均大于GWI 、GCW 、GWW 、GWE 单独预
测AUC(P <0.05)，见表3和图3。

2.5超声心肌做功参数与HCM 患者心血管事件发生的关系以ROC 曲线截断值为危险度界限，经HCM 患者心血管事件发生危险度分析，就诊时GWI 、GCW 、GWW 、GWE 所致RR 分别为10.400、1
3.450、0.105、5.716，差异均有统计学意义(P <0.05)，随访6个月GWI 、GCW 、GWW 、GWE 所致RR 分别为10.021、11.241、0.086、7.987，差异均有统计学意义(P <0.05)，见表4。

表2
两组患者的超声心肌做功参数比较(x -±s )
Table 2
Comparison of ultrasonic myocardial work parameters between the two groups of patients (x -±s )
时间就诊时
随访6个月
随访12个月
组别事件组对照组t 值P 值
事件组对照组t 值P 值
事件组对照组t 值P 值
例数46126
46126
46126GWI (mmHg%)1264.11±184.961892.05±231.8316.5390.001
1418.69±175.64a
1914.67±218.54a 13.8390.001
1546.29±183.59ab 2037.86±192.30ab 15.0160.001
GCW (mmHg%)1564.36±425.701843.64±197.785.8530.001
1735.22±273.64a
1955.61±210.73a 5.5850.001
1883.71±263.18ab 2236.51±243.67ab 8.2250.001
GWW (mmHg%)164.90±42.63131.41±28.725.8950.001147.92±35.37a
112.62±24.38a
7.3930.001134.58±23.72ab 109.82±28.96ab 5.1950.001
GWE (%)85.72±6.4891.67±1.529.6490.00188.35±4.79a 92.69±1.78a 8.6910.00190.47±4.53ab 94.36±2.14ab 7.6120.001
注：与就诊时比较，a P <0.05，与随访6个月比较，b
P <0.05；1mmHg=0.133kPa 。

Note:Compared with that at the time of the visit,a P <0.05,and compared with that at 6months of follow-up,b P <0.05;1mmHg=0.133kPa.
图1事件组患者的心肌做功参数及压力应变环图
Figure1Myocardial work parameters and stress strain ring diagram of patients in the event
group
图2对照组患者的心肌做功参数及压力应变环图
Figure2Myocardial work parameters and stress strain ring diagram in the control group
表3超声心肌做功参数对HCM患者心血管事件的预测价值
Table3Predictive value of ultrasonic myocardial work parameters for cardiovascular events in HCM patients
时间
就诊时
随访6个月
随访12个月
指标
GWI
GCW
GWW
GWE
联合预测
GWI
GCW
GWW
GWE
联合预测
AUC
0.787
0.734
0.733
0.770
0.922
0.769
0.773
0.710
0.731
0.943
95%CI
0.718~0.845
0.661~0.798
0.661~0.798
0.700~0.831
0.871~0.957
0.699~0.830
0.703~0.833
0.636~0.777
0.659~0.796
0.898~0.973
敏感度(%)
73.91
69.57
52.17
93.48
80.43
82.61
89.13
71.74
76.09
89.13
特异度(%)
77.78
69.84
96.03
50.00
88.89
64.29
57.14
65.08
63.49
89.68
P值
0.001
0.001
0.001
0.001
0.001
0.001
0.001
0.001
0.001
0.001
截断值
1297.33mmHg%
1751.47mmHg%
163.85mmHg%
93.84%
-
1549.49mmHg%
2003.66mmHg%
140.25mmHg%
91.20%
-
3讨论
HCM病理机制在于肌节蛋白基因突变损害心肌细胞收缩功能导致肌纤维、肌小节排列紊乱，引起房室收缩功能减退、代偿性心肌细胞肥大，进一步加重收缩及舒张功能障碍[8-10]。

早期HCM患者LVEF常常处于正常或稍高状态，无明显临床症状，但临床研究表明，心肌结构的改变已造成左心室收缩功能受损，易发生心血管事件[11]。

本研究常规超声参数中，就诊时、随访6个月、12个月时两组患者的LVEDV、LVESV、LVEF、BSA比较差异均无统计学意义。

LVEF是对左室腔内径变化的反映，而不是对心肌细胞本身收缩特性的反映，故HCM患者左室泵血功能相关指标无明显改变[12-14]。

此外，本研究中事件组患者的LADI、LA V、LAD、LA VI明显高于对照组，其原因主要是由于左室肥厚、心腔容积变小和(或)流出道梗阻，肥厚的心肌通过延长收缩持续时间、增强收缩力等自我调节机制克服每搏量下降，以维持体循环。

若能早期评估心血管事件发生风险，则可给予相应预防性干预，一定程度上改善HCM患者预后。

超声心肌做功参数中GWI为二尖瓣关闭至开放期间左心室心肌的做功总和；GWW表示能量损失，是左室收缩期伸展及等容舒张期缩短所做的功；GCW 表示心肌主动收缩做功，是左室舒张期伸展、等容收缩期缩短所做的功[15-17]。

本研究就诊时、随访6个月、12个月时，事件组患者的GWI、GCW、GWE明显低于对照组，GWW明显高于对照组，表明发生心血管事件的HCM患者左心室整体心肌能力受损，心肌做功效率减低，左室收缩舒张功能明显异于未发生心血管事件患者。

分析原因有两个方面，一是HCM患者左心室重构，心肌不均匀肥厚，导致心肌收缩不同步，影响左心室收缩功能，造成GWI、GCW、GWE降低[18-20]；二是HCM患者多伴有一定程度的微血管功能障碍，冠脉管壁及内膜增生，影响心肌供血，肥厚心肌导致毛细血管密度变小，加重心肌缺血，减低左室心肌做功[21-22]。

左室压力-应变环是通过测量上臂袖带肱动脉血压，经超声心动图获取左室应变曲线，结合左心室压力与应变，从而准确、无创评估左心室心肌做功的改变[23-24]。

就诊时、随访6个月GWI、GCW、GWW、GWE联合预测HCM患者心血管事件的AUC为0.922、0.943，均大于各项做功参数单独预测AUC，且经危险度分析，就诊时、随访6个月GWI、GCW、GWE高值、GWW低值可明显增加HCM患者心血管事件发生风险，提示GWI、GCW、GWW、GWE联合可作为预测HCM患者心血管事件的可靠指标。

表4超声心肌做功参数与HCM患者心血管事件发生的关系
Table4Relationship between ultrasonic myocardial work parameters and cardiovascular events in HCM patients
时间
就诊时
随访6个月指标
GWI
GCW
GWW
GWE
GWI
GCW
GWW
GWE
分类
<1297.33mmHg%
≥1297.33mmHg%
<1751.47mmHg%
≥1751.47mmHg%
<163.85mmHg%
≥163.85mmHg%
<93.84%
≥93.84%
<1549.49mmHg%
≥1549.49mmHg%
<2003.66mmHg%
≥2003.66mmHg%
<140.25mmHg%
≥140.25mmHg%
<91.20%
≥91.20%
发生(n=46)
39
7
40
6
9
37
34
12
38
8
39
7
8
38
35
11
P值
0.001
0.001
0.001
0.001
0.001
0.001
0.001
0.001
未发生(n=126)
21
105
17
109
111
15
23
103
17
109
18
108
114
12
14
112
RR(95%CI)
10.400(4.957~21.818)
13.450(6.061~29.850)
0.105(0.055~0.202)
5.716(3.212~10.174)
10.021(5.012~20.036)
11.241(5.367~23.542)
0.086(0.043~0.172)
7.987
(4.423~14.424)
图3超声心肌做功参数对HCM患者心血管事件的预测价值
Figure3Predictive value of ultrasonic myocardial work parameters
for cardiovascular events in HCM patients
综上所述，HCM患者超声心肌做功参数对心血管事件发生有较高预测价值，GWI、GCW、GWW、GWE 在发生心血管事件的HCM患者中存在明显变化，可有效提示HCM患者心血管事件危险度。

参考文献
[1]Bayonas-Ruiz A,Muñoz-Franco FM,Ferrer V,et al.Cardiopulmo-
nary exercise test in patients with hypertrophic cardiomyopathy:a sys-tematic review and meta-analysis[J].J Clin Med,2021,10(11):2312.
[2]Maron BJ,Desai MY,Nishimura RA,et al.Management of hypertro-
phic cardiomyopathy:JACC state-of-the-art review[J].J Am Coll Cardiol,2022,79(4):390-414.
[3]Li MZ,Li H,Meng H,et al.Correlation between left ventricular glob-
al and local myocardial function and myocardial fibrosis in hypertro-phic cardiomyopathy by ultrasonic speckle tracking[J].Molecular Cardiology of China,2022,22(1):4403-4408.
李慕子,李慧,孟红,等.超声斑点追踪技术评价肥厚型心肌病患者心肌功能及其与心肌纤维化的相关性[J].中国分子心脏病学杂志, 2022,22(1):4403-4408.
[4]Wang HJ,Xia J,Ma XJ.Research progress in evaluating left atrial
function in patients with hypertrophic cardiomyopathy using echocar-diography[J].Journal of Cardiovascular and Pulmonary Diseases, 2023,42(3):276-279.
王洪杰,夏娟,马小静.超声心动图评估肥厚型心肌病患者左心房功能的研究进展[J].心肺血管病杂志,2023,42(3):276-279. [5]Dorobantu DM,Wadey CA,Amir NH,et al.The role of speckle
tracking echocardiography in the evaluation of common inherited car-diomyopathies in children and adolescents:a systematic review[J].
Diagnostics(Basel),2021,11(4):635.
[6]Zhao QQ,Liu L,Cui CY,et al.Quantitative evaluation of left ventric-
ular global myocardial work in patients with non-obstructive hyper-trophic cardiomyopathy by pressure-strain loops[J].Chinese Journal of Ultrasound in Medicine,2020,36(9):795-798.
赵庆庆,刘琳,崔存英,等.左室压力-应变环对非梗阻型肥厚型心肌病患者整体心肌做功的定量研究[J].中国超声医学杂志,2020, 36(9):795-798.
[7]Compilation Group for the Diagnosis and Treatment Guidelines for
Chinese Adult Hypertrophic Cardiomyopathy,Cardiovascular Branch of the Chinese Medical Association,Editorial Committee of the Chi-nese Journal of Cardiovascular Disease.Guidelines for the diagnosis and treatment of Chinese adult hypertrophic cardiomyopathy[J].Chin J Cardiol,2017,45(12):1015-1032.
中华医学会心血管病学分会中国成人肥厚型心肌病诊断与治疗指南编写组,中华心血管病杂志编辑委员会.中国成人肥厚型心肌病诊断与治疗指南[J].中华心血管病杂志,2017,45(12):1015-1032.
[8]Eschenhagen T,Carrier L.Cardiomyopathy phenotypes in human-in-
duced pluripotent stem cell-derived cardiomyocytes—a systematic re-view[J].Pflugers Arch,2019,471(5):755-768.
[9]Yang Y,Wu D,Wang H,et al.Prognostic value of global longitudinal
strain in hypertrophic cardiomyopathy:a systematic review and me-ta-analysis[J].Clin Cardiol,2022,45(12):1184-1191.
[10]Guo HJ,Chen HX,Li J,et al.Relationships between clinical character-
istics and the extent of myocardial fibrosis assessed by cardiac mag-netic resonance in patients with hypertro phic cardiomyopathy[J].
South China Journal of Cardiovascular Diseases,2023,29(1):35-40.
郭会军,陈会校,李娟,等.肥厚型心肌病患者临床特征与基于心脏磁共振评估的心肌纤维化范围间的关系[J].岭南心血管病杂志, 2023,29(1):35-40.
[11]Ismayl M,Abbasi MA,Marar R,et al.Mavacamten treatment for hyper-
trophic cardiomyopathy:a systematic review and meta-analysis of ran-
domized controlled trials[J].Curr Probl Cardiol,2023,48(1):101429.
[12]Alphonse P,Virk S,Collins J,et al.Prognostic impact of atrial fibrilla-
tion in hypertrophic cardiomyopathy:a systematic review[J].Clin Res Cardiol,2021,110(4):544-554.
[13]Akhtar H,Al Sudani H,Hussein M,et al.Effects of renin-angioten-
sin-aldosterone system inhibition on left ventricular hypertrophy,dia-stolic function,and functional status in patients with hypertrophic car-diomyopathy:a systematic review[J].Cureus,2022,14(7):26642. [14]Bayonas-Ruiz A,Muñoz-Franco FM,Sabater-Molina M,et al.Current
therapies for hypertrophic cardiomyopathy:a systematic review and meta-analysis of the literature[J].ESC Heart Fail,2023,10(1):8-23.
[15]Xiao MH,Wang JJ,Wang SY,et al.Myocardial work in patients with
non-obstructive hypertrophic cardiomyopathy[J].Chinese Journal of Ultrasound in Medicine,2021,37(6):649-651.
肖明虎,王婧金,王水云,等.心肌做功在非梗阻性肥厚型心肌病中的应用[J].中国超声医学杂志,2021,37(6):649-651.
[16]Tomoaia R,Beyer RS,Zdrenghea D,et al.Global work index by
non-invasive pressure-strain loops:a novel parameter to assess left ventricular performance in the early stages of heart failure with pre-served or mid-range ejection fraction after acute myocardial infarc-tion[J].Med Ultrason,2021,23(1):62-69.
[17]Yang C,Guo Y,Wang X,et al.The value of myocardial work in as-
sessment of ventricular function in patients with non-obstructive hy-pertrophic cardiomyopathy[J].BMC Cardiovasc Disord,2022,22
(1):305.
[18]Pham TTM,Truong VT,Vu PN,et al.Echocardiographic reference
ranges of non-invasive myocardial work indices in children[J].Pedi-atr Cardiol,2022,43(1):82-91.
[19]Ding J,Sun HG,Liu J,et al.Assessment of left ventricular myocardi-
al work done by noninvasive pressure-strain loop technique in pa-tients with essential hypertension[J].Ann Noninvasive Electrocardi-ol,2022,27(6):12983.
[20]Zhang J,Wang J,Zhu XL,et al.Assessment of left ventricular dysfunc-
tion of sarcomere mutation carriers in hypertrophic cardiomyopathy by three-dimensional speckle tracking imaging combined with conven-tional echocardiography[J].Chin J Ultrasonogr,2019,29(2):104-109.
张娟,王静,朱晓丽,等.三维斑点追踪技术联合常规超声心动图评价肥厚型心肌病肌小节突变携带者左心室功能的早期改变[J].中华超声影像学杂志,2019,29(2):104-109.
[21]Seco M,Lau JC,Medi C,et al.Atrial fibrillation management during
septal myectomy for hypertrophic cardiomyopathy:a systematic re-view[J].Asian Cardiovasc Thorac Ann,2022,30(1):98-107. [22]Lei CH,Liu LW,Tuo SJ,et al.Role of three-dimensional speckle
tracking imaging in predicting the prognosis of light-chain cardiac amyloidosis with normal left ventricular ejection fraction[J].Chin J Ultrasonogr,2021,31(4):277-282.
雷常慧,刘丽文,拓胜军,等.三维斑点追踪成像评估左室射血分数正常的轻链型心肌淀粉样变预后的临床价值[J].中华超声影像学杂志,2021,31(4):277-282.
[23]Zhang M,Y uan JJ,Wang YS,et al.Application of pressure-strain
loop in evaluating left ventricular myocardial function in hypertro-phic cardiomyopathy[J].Chin J Ultrasonogr,2020,29(7):576-580.
张苗,袁建军,王一洒,等.压力-应变环在评价肥厚型心肌病左室心肌做功中的应用[J].中华超声影像学杂志,2020,29(7):576-580.
[24]He SL,Hou XT,Si XF,et al.Clinical application of ultrasonic noninva-
sive myocardial work detection technology in left ventricular systolic function before and after percutaneous coronary intervention forcoronary artery disease[J].J Chin Clin Med Imag,2022,33(6):396-400,403.
贺诗岚,候雪婷,司雪霏,等.超声无创心肌做功技术在冠心病经皮冠状动脉介入治疗前后左室收缩功能中的临床应用[J].中国临床医学影像杂志,2022,33(6):396-400,403.
(收稿日期：2023-07-19)。