摘要
目的探讨超声分层应变成像参数联合实验室指标对急性ST段抬高型心肌梗死(STEMI)后左心室不良重构(LVAR)的预测价值。方法选取2022年1月至2024年1月在大庆油田总医院进行经皮冠状动脉介入术(PCI)的106例急性STEMI患者,根据影像学检查结果是否发生LVAR将患者分为发生组(31例)、未发生组(75例)。比较两组患者一般资料、实验室指标、常规超声指标[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)及左心房容积(LAVI)]、超声分层应变成像指标[左心室心肌整体纵向应变(GLS)、左心室整体收缩期圆周应变(GCS)以及峰值应变离散度(PSD)],采用Logistic回归模型分析发生LVAR的危险因素,采用受试者工作特征(ROC)曲线分析超声分层应变成像技术对急性STEMI患者LVAR的预测价值。结果发生组患者Killip分级≥2级占比高于未发生组(P<0.05);发生组患者基线心肌肌钙蛋白I(cTn-I)、肌酸激酶同工酶(CK-MB)、肌红蛋白水平、血浆N末端B型钠尿肽原(NT-proBNP)水平均高于未发生组(P<0.05);发生组患者GLS_内、PSD均高于未发生组(P<0.05);经多因素Logistic回归模型分析,基线cTn-I、术后1周GLS_内、术后1周PSD均为发生LVAR的独立危险因素(P<0.05);ROC曲线分析显示,基线cTn-I、术后1周GLS_内、术后1周PSD单独及联合预测急性STEMI后LVAR的AUC(0.95CI)分别为0.794(0.704~0.866)、0.832(0.747~0.898)、0.831(0.746~0.897)及0.948(0.887~0.982),且三项联合预测效能高于各项单独预测(P<0.05)。结论术后1周应用超声分层应变成像技术有助于预测急性STEMI后LVAR,基线实验室指标cTn-I与术后1周GLS_内、PSD三者联合对预测LVAR具有重要参考价值。
Objective To investigate the predictive value of ultrasound stratified strain imaging parameters combined with laboratory indices for left ventricular adverse remodeling(LVAR)after acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 106 patients with acute STEMI who underwent percutaneous coronary intervention(PCI)in the Daqing Oilfield General Hospital from January 2022 to January 2024 were selected and were categorized into the occurrence group(31 cases)and the non-occurrence group(75 cases)according to whether LVAR occurred in the imaging findings.The general data,laboratory indexes,conventional ultrasound indexes[left ventricular ejection fraction(LVEF),left ventricular end-diastolic internal diameter(LVEDD),left ventricular end-systolic internal diameter(LVESD),left atrial volume(LAVI)],ultrasound stratified strain imaging indexes[left ventricular myocardial global longitudinal strain(GLS),left ventricular global systolic circumferential strain(GCS)and peak strain dispersion(PSD)]were compared between the two groups.Logistic regression models were used to analyze the risk factors for the occurrence of LVAR,and the predictive value of ultrasound stratified strain imaging for LVAR in patients with acute STEMI was analyzed using the subject's work characteristics(ROC)curve.Results The percentage of patients with Killip classification≥grade 2 was higher isoenin the occurrence group than in the non-occurrence group(P<0.05).The baseline cardiac troponin I(cTn-I),creatine kinase isoenzyme(CK-MB),myoglobin level,and plasma N-terminal B-type natriuretic peptide precursor(NT-proBNP)level were higher in the occurrence group than in the non-occurrence group(P<0.05).Both the GLS and PSD in the occurrence group were higher than those in the non-occurrence group(P<0.05).Multifactorial Logistic regression model showed that the baseline cTn-I,intra-GLS at 1 week postoperatively and postoperative PSD at 1 week postoperatively were the independent risk factors for the occurrence of LVAR(P<0.05).ROC curve analysis showed that the AUC(0.95CI)of baseline cTn-I,1-week postoperative GLS and PSD for predicting LVAR after acute STEMI alone and in combination were 0.794(0.704-0.866),0.832(0.747-0.898),0.831(0.746-0.897)and 0.948(0.887-0.982),and the efficacy of the three combined predictions was higher than that of each individual prediction(P<0.05).Conclusion The application of ultrasound stratified strain imaging at 1 week postoperatively would help to predict LVAR after acute STEMI,and the combination of the baseline laboratory index cTn-I with intraoperative GLS and PSD at 1 week postoperatively is an important reference for the prediction of LVAR.
作者
王磊
王涵
赵德霞
李洋
WANG Lei;WANG Han;ZHAO De-xia;LI Yang(Ultrasound Department of Daqing Oilfield General Hospital,Daqing 163001,China)
出处
《中国心血管病研究》
2025年第1期40-46,共7页
Chinese Journal of Cardiovascular Research
基金
大庆市指导性科技计划项目(dy202470)。
关键词
急性ST段抬高型心肌梗死
超声分层应变成像技术
左心室不良重构
Acute ST-segment elevation myocardial infarction
Ultrasound stratified strain imaging
Adverse left ventricular remodeling
