摘要
目的探讨心外膜脂肪组织(EAT)厚度联合心肌做功参数对稳定型冠心病患者经皮冠状动脉介入治疗(PCI)后发生主要不良心血管事件(MACE)及再次血运重建的预测价值。方法本研究为回顾性队列研究。选取2020年10月—2022年10月西安交通大学第一附属医院收治的新诊断的稳定型冠心病患者94例为研究对象。收集患者的临床资料、超声心动图检查指标。根据MACE发生情况将患者分为MACE组和非MACE组,根据再次血运重建情况将患者分为血运重建组和非血运重建组。采用多因素Cox比例风险回归分析探讨稳定型冠心病患者PCI后发生MACE及再次血运重建的影响因素;采用ROC曲线分析EAT厚度、纵向应变及二者联合预测稳定型冠心病患者PCI后发生MACE及再次血运重建的价值。结果22例患者发生MACE,17例患者再次血运重建。MACE组男性占比低于非MACE组,EAT厚度、纵向应变大于非MACE组(P<0.05);血运重建组男性占比低于非血运重建组,EAT厚度、纵向应变高于非血运重建组(P<0.05)。多因素Cox比例风险回归分析结果显示,EAT厚度〔HR=3.987,95%CI(1.574~10.096)〕、纵向应变〔HR=1.312,95%CI(1.122~1.533)〕是稳定型冠心病患者PCI后发生MACE的独立影响因素(P<0.05),性别〔HR=3.268,95%CI(1.100~9.701)〕、EAT厚度〔HR=3.982,95%CI(1.328~11.942)〕、纵向应变〔HR=1.230,95%CI(1.027~1.473)〕是稳定型冠心病患者PCI后再次血运重建的独立影响因素(P<0.05)。ROC曲线分析结果显示,EAT厚度、纵向应变及二者联合预测稳定型冠心病患者PCI后发生MACE的AUC分别为0.855〔95%CI(0.750~0.959)〕、0.905〔95%CI(0.846~0.964)〕、0.919〔95%CI(0.864~0.973)〕;EAT厚度、纵向应变及二者联合预测稳定型冠心病患者PCI后再次血运重建的AUC分别为0.803〔95%CI(0.692~0.914)〕、0.812〔95%CI(0.727~0.897)〕、0.837〔95%CI(0.751~0.924)〕。结论EAT厚度、纵向应变是稳定型冠心病患者PCI后发生MACE及再次血运重建的独立影响因素,二者联合对稳定型冠心病患者PCI后发生MACE有较高预测价值,而对再次血运重建有一定预测价值。
Objective To explore the predictive value of epicardial adipose tissue(EAT)thickness combined with myocardial work parameters on major adverse cardiovascular events(MACE)and revascularization after percutaneous coronary intervention(PCI)in patients with stable coronary heart disease.Methods This study is a retrospective cohort study.A total of 94 newly diagnosed stable coronary heart disease patients admitted to the First Affiliated Hospital of Xi'an Jiaotong University from October 2020 to October 2022 were selected as the research subjects.The clinical data and echocardiographic examination indicators of the patients were collected,the patients were divided into MACE group and non-MACE group according to the occurrence of MACE,the patients were divided into revascularization group and non-revascularization group according to the occurrence of revascularization.Multivariate Cox proportional risk regression analysis was used to explore the influencing factors of MACE and revascularization after PCI in patients with stable coronary heart disease.The ROC curve was used to explore the predictive value of the EAT thickness,longitudinal strain and their combination for MACE and revascularization after PCI in patients with stable coronary heart disease.Results Twenty-two patients developed MACE,and 17 patients underwent revascularization.The proportion of males in MACE group was lower than that in non-MACE group,the EAT thickness and longitudinal strain were larger than those in non-MACE group(P<0.05).The proportion of males in revascularization group was lower than that in non-revascularization group,the EAT thickness and longitudinal strain were larger than those in non-revascularization group(P<0.05).Multivariate Cox proportional risk regression analysis showed that EAT thickness[HR=3.987,95%CI(1.574-10.096)],longitudinal strain[HR=1.312,95%CI(1.122-1.533)]were independent influencing factors of MACE after PCI in patients with stable coronary heart disease(P<0.05),and gender[HR=3.268,95%CI(1.100-9.701)],EAT thickness[HR=3.982,95%CI(1.328-11.942)],longitudinal strain[HR=1.230,95%CI(1.027-1.473)]were independent influencing factors of revascularization after PCI in patients with stable coronary heart disease(P<0.05).ROC curve analysis showed that the AUC of EAT thickness,longitudinal strain and their combination in predicting MACE after PCI in patients with stable coronary heart disease was 0.855[95%CI(0.750-0.959)],0.905[95%CI(0.846-0.964)]and 0.919[95%CI(0.864-0.973)],respectively;the AUC of EAT thickness,longitudinal strain and their combination in predicting revascularization after PCI in patients with stable coronary heart disease was 0.803[95%CI(0.692-0.914)],0.812[95%CI(0.727-0.897)]and 0.837[95%CI(0.751-0.924)],respectively.Conclusion EAT thickness and longitudinal strain are independent influencing factors of MACE and revascularization after PCI in patients with stable coronary heart disease,their combination has high predictive value for MACE and a certain predictive value for revascularization after PCI in patients with stable coronary heart disease.
作者
张粉丽
赵颖辉
ZHANG Fenli;ZHAO Yinghui(Department of Structural Cardiology,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Cardiovascular Disease,Xi'an No.5 Hospital/Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shaanxi University of Chinese Medicine,Xi'an 710082,China)
出处
《实用心脑肺血管病杂志》
2024年第8期13-18,共6页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
基金
陕西省卫生健康科研项目(202011731)。
