cardiotomskСибирский журнал клинической и экспериментальной медициныSiberian Journal of Clinical and Experimental Medicine2713-29272713-265XTSU publishing10.29001/2073-8552-2023-39-3-75-85cardiotomsk-1945Research ArticleКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯCLINICAL STUDIESПоказатели глобальной миокардиальной работы левого желудочка при стресс-эхокардиографии с физической нагрузкой в диагностике стабильной ишемической болезни сердцаIndicators of global myocardial work of the left ventricle during exercise stress echocardiography in the diagnosis of stable coronary heart diseasehttps://orcid.org/0000-0002-9725-7528АлёхинМ. Н.AlekhinM. N.

Алёхин Михаил Николаевич, д-р мед. наук, заслуженный врач Российской Федерации, профессор кафедры терапии, кардиологии и функциональной диагностики с курсом нефрологии; заведующий отделением функциональной диагностики

121359, Российская Федерация, Москва, ул. Маршала Тимошенко, 19, стр. 1а; 121359, Российская Федерация, Москва, ул. Маршала Тимошенко, 15 

Mikhail N. Alekhin, Dr. Sci. (Med.), Honored Doctor of the Russian Federation, Professor, Department of Therapy, Cardiology and Functional Diagnostics with Nephrology Course; Head of Functional Diagnostics Department

19, stroenie 1А, Marshala Timoshenko str., Moscow, 121359, Russian Federation; 15, Marshala Timoshenko str., Moscow, 121359, Russian Federation 

amn@mail.ruhttps://orcid.org/0000-0002-6768-1045ИвановС. И.IvanovS. I.

Иванов Сергей Игоревич, аспирант, кафедра терапии, кардиологии и функциональной диагностики с курсом нефрологии

121359, Российская Федерация, Москва, ул. Маршала Тимошенко, 19, стр. 1а

Sergey I. Ivanov, Graduate Student, Department of Therapy, Cardiology and Functional Diagnostics with Nephrology Course

19, stroenie 1А, Marshala Timoshenko str., Moscow, 121359, Russian Federation

1539ivanov@mail.ruhttps://orcid.org/0000-0001-8085-3166РадоваН. Ф.RadovaN. F.

Радова Наталья Федоровна, канд. мед. наук, доцент кафедры терапии, кардиологии и функциональной диагностики с курсом нефрологии; врач отделения функциональной диагностики

121359, Российская Федерация, Москва, ул. Маршала Тимошенко, 19, стр. 1а; 121359, Российская Федерация, Москва, ул. Маршала Тимошенко, 15 

Natalya F. Radova, Associate Professor, Department of Therapy, Cardiology and Functional Diagnostics with Nephrology Course; Doctor, Functional Diagnostics Department

19, stroenie 1А, Marshala Timoshenko str., Moscow, 121359, Russian Federation; 15, Marshala Timoshenko str., Moscow, 121359, Russian Federation 

radova.natalia@yandex.ruЦентральная государственная медицинская академия Управления делами Президента Российской Федерации; Центральная клиническая больница с поликлиникой Управления делами Президента Российской ФедерацииРоссияCentral State Medical Academy of Department of Presidential Affairs, Central State Medical Academy of the Office of the President of the Russian Federation; Central Clinical Hospital of the Presidential Administration of the Russian FederationRussian FederationЦентральная государственная медицинская академия Управления делами Президента Российской ФедерацииРоссияCentral State Medical Academy of Department of Presidential Affairs, Central State Medical Academy of the Office of the President of the Russian FederationRussian Federation2023111020233837585Copyright © Алёхин М.Н., Иванов С.И., Радова Н.Ф., 20232023Алёхин М.Н., Иванов С.И., Радова Н.Ф.Alekhin M.N., Ivanov S.I., Radova N.F.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sibjcem.ru/jour/article/view/1945Цель

Цель: определение возможности выявления пациентов со значимым поражением коронарного русла с помощью оценки показателей глобальной миокардиальной работы левого желудочка (ЛЖ) путем построения кривых давление-деформация при стресс-эхокардиографии (стресс-ЭхоКГ) с физической нагрузкой.

Материал и методы

Материал и методы. В исследование были включены 136 пациентов в возрасте от 36 до 84 лет, из них 97 (71%) мужчин, с предполагаемой или подтвержденной ранее ишемической болезнью сердца (ИБС), которым были выполнены стресс-ЭхоКГ с тредмилом по протоколу Bruce. С помощью методики построения кривых давление-деформация в покое и на максимуме нагрузки рассчитывали индекс глобальной миокардиальной работы ЛЖ (GWI), глобальную конструктивную работу (GCW), глобальную потерянную работу (GWW), эффективность глобальной миокардиальной работы (GWE). Пациентам проводилась селективная коронароангиография (КАГ), по результатам которой они были разделены на 3 группы: 51 пациент без значимого поражения коронарных артерий (КА) – контрольная группа, 57 пациентов с однососудистым и 28 пациентов с многососудистым поражением КА. Различия признавались достоверными при уровне значимости р < 0,05.

Результаты

Результаты. При сравнении с контрольной группой у пациентов с однососудистым поражением КА в покое были достоверно меньше GWE и больше GWW. На максимуме нагрузки у этих пациентов GWI, GCW и GWE были достоверно ниже, а GWW достоверно больше. У пациентов с многососудистым поражением КА все показатели значимо отличались от контрольной группы как в покое, так и на максимуме нагрузки. Значения GWI на максимуме нагрузки ≤ 2553 мм рт. ст.% позволяли заподозрить наличие значимого поражения КА с чувствительностью 62% и специфичностью 95% (площадь под кривой AUC 0,79 ± 0,05; р < 0,001).

Заключение

Заключение. Оценка показателей глобальной миокардиальной работы ЛЖ с помощью построения кривых давление-деформация может быть использована при стресс-ЭхоКГ с физической нагрузкой для совершенствования отбора пациентов, нуждающихся в проведении коронарного вмешательства.

Aim

Aim: To determine the possibility of identifying patients with significant coronary artery disease (CAD) by evaluation of the global left ventricular (LV) myocardial work indicators by constructing pressure-strain loops during exercise stress echocardiography.

Material and Methods

Material and Methods. The study included 136 patients aged 36 to 84 years, of which 97 (71%) men, with suspected or previously confirmed CAD, who underwent stress echocardiography on the treadmill according to the Bruce protocol. LV myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW) and global myocardial work efficiency (GWE) were evaluated using the technique of constructing pressure-strain loops at rest and at peak exercise. All patients underwent selective coronary angiography, according to the results of which they were divided into 3 groups: 51 patients without coronary artery lesions – the control group, 57 patients with single-vessel CAD and 28 patients with multi-vessel CAD. Significant lesion was defined as ≥ 70% artery luminal narrowing. All tests were two-sided and P-values < 0.05 were considered statistically significant.

Results

Results. Compared with the control group, patients with single-vessel CAD at rest had significantly less GWE and more GWW. In these patients GWI, GCW and GWE at peak exercise were significantly lower, and GWW was significantly higher. In patients with multi-vessel CAD, all global LV myocardial work indicators significantly differed from the control group both at rest and at peak exercise. The optimal cutoff value of GWI at peak exercise to predict significant CAD was 2553 mmHg% with a sensitivity of 62% and a specificity of 95% (AUC 0.79 ± 0.05, p < 0.001).

Conclusions

Conclusions. The evaluation of global LV myocardial work indicators by constructing pressure-strain loops can be used in exercise stress echocardiography to improve the selection of patients requiring coronary intervention.

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The authors declare that there are no conflicts of interest present.