摘要
目的探讨心肌声学造影(MCE)在评估急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术后微循环灌注及预后中的应用价值。方法选择2021年2月至2023年8月期间于石家庄市人民医院心内科和胸痛中心收治的319例急性ST段抬高型心肌梗死(STEMI)患者为研究对象。所有患者均在PCI术后7 d内接受超声心动图和MCE检查。根据MCE结果分为冠状动脉微循环障碍(CMD)组和非CMD组。比较两组患者临床资料及MCE相关参数。PCI术后进行随访,记录期间主要心脏不良事件(MACE)发生情况。结果经MCE检测后共60.50%的患者检出CMD。CMD组患者患者肌钙蛋白I(cTnI)、N末端脑钠肽前体(NT-proBNP)、室壁运动评分指数(WMSI)、Killip高分级和节段性室壁运动异常(RWMA)患者比例均显著高于非CMD组(P<0.05),而左心室射血分数(LVEF)、左心室整体纵向应变(GLS)显著低于非CMD组(P<0.05)。CMD组MACE发生率显著高于非CMD组(P<0.05)。患者接受12.0(1.0~26.5)个月的随访。在校正了GRACE风险评分、峰值cTnI和峰值NT-proBNP后,CMD仍是MACE的独立预测因子[校正比值比(OR):2.457;95%置信区间(CI):1.042~5.790;P=0.040],CMD患者因心力衰竭住院的风险更高(校正OR:2.115;95%CI:1.372~3.260;P=0.031)。Kaplan-Meier曲线显示,与非CMD患者相比,CMD患者PCI术后中位无MACE生存时间更短,无MACE生存率更低,差异有统计学意义(P=0.001)。结论MCE是一种低廉、无创、安全有效的监测微循环灌注和识别CMD发生的有用工具。MCE检测的CMD与AMI患者PCI后MACE风险增加显著相关。
Objective To investigate the value of myocardial contrast echocardiography(MCE)in evaluating microcirculation perfusion and prognosis of patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods A total of 319 patients with acute ST-segment elevation myocardial infarction(STEMI)admitted to the Department of Cardiology and Chest Pain Center of Shijiazhuang People's Hospital from February 2021 to August 2023 were selected as the study subjects.All patients underwent echocardiography and MCE within 7 days after PCI.According to the MCE results,the patients were divided into coronary microcirculation disorder(CMD)group and non-CMD group.The clinical data and MCE parameters of the two groups were compared.Major adverse cardiac events(MACE)were followed up after PCI.Results CMD was detected in 60.50%(193/319)of patients with MCE.Troponin I(cTnI),N-terminal B-type natriuretic peptide precursors(NT-proBNP),wall movement score index(WMSI),and the proportion of patients with high Killip grade and regional wall motion abnormality(RWMA)were significantly higher in CMD group than in non-CMD group(P<0.05),while left ventricular ejection fraction(LVEF)and left ventricular global longitudinal strain(GLS)were significantly lower than those in non-CMD group(P<0.05).The incidence of MACE in CMD group was significantly higher than that in non-CMD group(P<0.05).Patients were followed for 12.0(1.0~26.5)months.After adjusting for GRACE risk score,peak cTnI,and peak NT-proBNP,CMD remained an independent predictor of MACE[Adjusted odds ratio(OR):2.457;95%confidence interval(CI):1.042~5.790;P=0.040],and patients with CMD had a higher risk of hospitalization for heart failure(adjusted OR:2.115;95%CI:1.372~3.260;P=0.031).Kaplan-Meier curve showed that compared with non-CMD patients,CMD patients had shorter median MACE free survival time and lower MACE free survival rate after PCI,with statistical significance(P=0.001).Conclusion MCE is an inexpensive,non-invasive,safe and effective tool for monitoring microcirculation perfusion and identifying CMD occurrence.CMD measured by MCE was also significantly associated with an increased risk of MACE in AMI patients after PCI.
作者
韩卫卫
胡钦
周峰
王立美
Han Weiwei;Hu Qin;Zhou Feng;Wang Limei(Department of Cardiovascular Blood,Shijiazhuang People's Hospital,Shijiazhuang 050000,China;不详)
出处
《中国循证心血管医学杂志》
2025年第3期327-332,共6页
Chinese Journal of Evidence-Based Cardiovascular Medicine
基金
河北省石家庄市科学技术研究与发展自筹计划项目(221200723)。
关键词
心肌声学造影
急性心肌梗死
冠状动脉微循环障碍
主要不良心血管事件
Myocardial contrast echocardiography
Acute myocardial infarction
Coronary microvascular dysfunction
Major adverse cardiovascular event
