Evaluation of left ventricular systolic function in amateur Marathon runners through ECG mode combined with two-dimensional speckle tracking technique
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摘要: 目的 探讨业余马拉松跑者心电图SV1+RV5水平与左心室整体纵向应变(global longitudinal strain，GLS)的相关性，评价业余马拉松跑者早期左心室收缩功能。方法 选取2022年9月—2023年9月于常州市第一人民医院超声心动室检查的102位业余马拉松跑者，收集及记录临床资料，采集心电图检查资料，记录受检者SV1+RV5、RaVL+SV3，获取室间隔厚度(interventricular septal thickness，IVST)、左心室舒张末期内径(left ventricular end-diastolic diameter，LVEDD)、左心室后壁厚度(left ventricular posterior wall thickness，LVPWT)、左心室质量指数(left ventricular mass index，LVMI)、左心室射血分数(left ventricular ejection fraction，LVEF)。应用二维斑点追踪成像(two-dimensional speckle tracking imaging，2D-STI)技术获取所有受检者的左心室整体纵向应变值(global longitudinal strain，GLS)。102位业余马拉松跑者按心电图SV1+RV5值的从小到大排列，再按入组人数三分位分组，其中低位组34例、中位组33例、高位组35例。比较各组一般临床资料。采用线性回归分析各参数与GLS的关系。使用广义相加模型(generalized additive model，GAM)分析SV1+RV5与GLS的关系。结果 3组间性别、吸烟史、饮酒史、高血压史、体表面积(body surface area，BSA)、LVMI、SV1+RV5、LVEDD、IVST、LVPWT、GLS均差异有统计学意义(均P < 0.05)。线性回归分析显示，SV1+RV5与GLS独立相关，且随着SV1+RV5的升高，GLS也逐渐升高(P < 0.05)。曲线拟合显示SV1+RV5与GLS呈现正相关。结论 马拉松跑者的左心室GLS与SV1+RV5独立相关，且随着SV1+RV5的升高，GLS也逐渐升高。将两者结合可早期发现左心室收缩功能的异常，这对于预防不良心血管病事件的发生有积极的作用。Abstract: Objective To investigate the correlation between the level of SV1+RV5 in electrocardiogram and the global longitudinal strain(GLS) of left ventricle, and evaluate early left ventricular systolic function in amateur Marathon runners.Methods A total of 102 amateur Marathon runners were selected for echocardiography examination in The First People's Hospital of Changzhou from December 2019 to December 2022. Clinical data were collected and recorded, ECG data were collected, and the value of SV1+RV5, RaVL+SV3 of the subjects were recorded. Interventricular septal thickness(IVST), left ventricular end-diastolic diameter(LVEDD), left ventricular posterior wall thickness(LVPWT), left ventricular mass index(LVMI), left ventricular ejection fraction(LVEF). Two-dimensional speckle tracking imaging(2D-STI) technique was applied to obtain global longitudinal strain(GLS). Divide the 102 amateur marathon runners into tertiles based on the ECG SV1+RV5 value from the smallest to the largest, and then according to the number of participants, with low group of 34, middle group of 33, high group of 35. General data among the three groups were compared. The relationship between each parameter and GLS was analyzed by linear regression. Generalized additive model(GAM) was used to analyze the relationship between GLS and SV1+RV5.Results There were statistically significant differences among the three groups in gender, total horse participation times, best half-horse performance, smoking history, drinking history, hypertension history, systolic blood pressure, BSA, LVMI, SV1+RV5, LVEDD, IVST, LVPWT, and GLS(all P < 0.05). Linear regression analysis showed that there was an independent correlation between SV1+RV5 and GLS, and with the increase of SV1+RV5, the GLS value also gradually increased(P < 0.05). Curve fitting showed that SV1+RV5 was positively correlated with GLS.Conclusion The left ventricular GLS of Marathon runners is independently correlated with SV1+RV5, and with the increase of SV1+RV5, the GLS value also gradually increases. The combination of the two can detect the abnormal left ventricular systolic function early, which is crucial for preventing the occurrence of adverse cardiovascular events.
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图 1 SV1+RV5水平与左室GLS之间的关系
Figure 1. The relationship between SV1+RV5 level and left ventricular GLS
图 2 分层分析方法进一步评估GLS在各个亚组间与SV1+RV5的关联
Figure 2. Hierarchical analysis further evaluated the association of GLS with SV1+RV5 across subgroups
表 1 3组临床资料比较
Table 1. Comparison of clinical data among the three groups
例(%), X±S 项目 低位组(34例) 中位组(33例) 高位组(35例) P SV1+RV5/mV < 2.190 2.190~2.760 ＞2.760 年龄/岁 46.412±7.165 45.152±8.348 48.229±7.413 0.253 男性 10(29.412) 23(69.697) 28(80.000) < 0.001 跑龄 0.867 < 1年 2(5.882) 1(3.125) 1(2.857) ≥1~ < 3年 16(47.059) 11(34.375) 14(40.000) ≥3~ < 6年 10(29.412) 15(46.875) 14(40.000) ≥6年 6(17.647) 5(15.625) 6(17.143) 平均月跑量 0.138 < 100 km 14(41.176) 8(24.242) 4(11.429) ≥100~ < 200 km 10(29.412) 12(36.364) 17(48.571) ≥200~ < 300 km 9(26.471) 12(36.364) 11(31.429) ≥300 km 1(2.941) 1(3.030) 3(8.571) 吸烟史 1(2.941) 9(27.273) 7(20.000) 0.023 饮酒史 4(11.765) 7(21.212) 14(40.000) 0.021 高血压史 5(14.706) 2(6.061) 11(31.429) 0.020 糖尿病史 1(2.941) 0 1(2.857) 0.614 BSA/m2 1.643±0.170 1.743±0.172 1.728±0.150 0.029 LVMI/(g/m2) 83.002±10.727 89.038±17.963 99.336±20.637 < 0.001 BMI/(kg/m2) 22.321±2.246 23.530±2.512 22.852±2.312 0.115 LVEDD/mm 47.676±3.273 49.212±3.655 50.200±4.050 0.019 IVST/mm 8.529±0.706 8.970±0.883 9.571±1.357 < 0.001 LVPWT/mm 8.471±0.662 8.909±0.805 9.314±1.157 < 0.001 LVEF/% 64.735±1.814 64.697±2.756 64.171±2.728 0.572 GLS/% -23.000±1.934 -22.400±2.281 -21.026±2.475 0.001 SV1+RV5/mV 1.765±0.285 2.517±0.176 3.597±0.797 < 0.001 RaVL+SV3/mV 0.860±0.465 0.888±0.486 1.019±0.645 0.431 注：1 mmHg=0.133 kPa。 
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表 2 各参数与左心室GLS的线性回归分析
Table 2. Parameters and left ventricular GLS analyzed by linear regression analysis
自变量 β(95%CI) P 年龄 0.02(-0.03~0.08) 0.400 性别(男性) -1.39(-2.29~-0.48) 0.003 LVMI 0.09(-0.01~0.03) 0.438 LVEDD 0.03(-0.08~0.15) 0.603 IVST 0.41(0.02~0.79) 0.041 LVPWT 0.51(0.03~0.99) 0.031 LVEF -0.11(-0.29~0.06) 0.062 SV1+RV5 1.03(0.56~1.43) < 0.001 RaVL+SV3 0.27(-0.53~1.08) 0.508
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表 3 SV1+RV5与GLS的相关性分析
Table 3. Correlation analysis between SV1+RV5 and GLS
模型1 模型2 模型3 β(95%CI) P β(95%CI) P β(95%CI) P SV1+RV5 0.998(0.562~1.433) < 0.000 1 0.891(0.424~1.357) < 0.000 1 0.873(0.332~1.413) 0.002 SV1+RV5分组 低位组 参考 参考 参考 中位组 1.364(0.369~2.358) 0.008 1.227(0.202~2.252) 0.021 1.081(0.007~2.155) 0.051 高位组 1.974(0.994~2.954) < 0.000 1 1.720(0.706~2.733) 0.001 1.595(0.454~2.735) 0.007
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