摘要
目的探讨心电图形态-电压-P波持续时间(MVP)评分对心肌梗死患者经皮冠状动脉介入治疗(PCI)术后不良心血管事件(MACE)的预测价值。方法选取2021年2月—2024年8月池州市第二人民医院心内科就诊的90例心肌梗死患者,根据PCI术后6个月内患者是否发生MACE,将其分为MACE组(26例)和非MACE组(64例),对比分析两组的一般资料、心电图指标[Ⅰ导联P波电压(PVLⅠ)、下壁导联P波形态(PWM)及P波时限(PWD)、心电图MVP评分、ST段抬高(STE)、校正的QT间期(cQT)、校正的QT间期离散度(cQTd)、校正的Tp-e间期(cTp-e)、Tp-e间期与QT间期的比值(Tp-e/QT)]以及心功能指标[左心室射血分数(LVEF)及左心房前后径(LAD)]水平。采用Cox回归分析模型分析MVP评分与MACE的关系,受试者工作特征(ROC)曲线评估其预测能力,局部加权回归散点平滑(Lowess)曲线分析相关性,亚组森林图探讨影响因素。结果与非MACE组比较,MACE组的LAD、PWD、PVLⅠ、PWM、MVP评分以及STE、cQTd、cTp-e和Tp-e/QT水平显著升高,LVEF水平降低;患者PCI术后MACE的发病率69.23%更高(P<0.05);Cox回归分析模型分析表明,随着MVP评分的增加,患者MACE发生的风险升高54.2%(HR=1.542,95%CI:1.287~1.641,P<0.05);ROC曲线表明,相较于PWD、PVLⅠ和PWM评分,MVP评分对于术后6个月内发生MACE的预测能力最高,其曲线下面积(AUC)为0.835(95%CI:0.678~0.922,P<0.05);Lowess曲线表明,MVP评分与术后6个月内发生MACE呈正相关;亚组分析显示,在LAD≥38.45 mm、LVEF<63.17%、STE≥82.54 uV、cQTd≥43.55 ms亚组中,MVP评分与术后6个月内MI患者MACE发生率的相关性更高。结论心电图MVP评分是心肌梗死患者PCI术后6个月内发生MACE的独立预测指标,其预测能力显著优于单一P波参数;MVP评分与MACE风险呈正相关,并在高LAD、STE、cQTd和低LVEF亚组中相关性更高,是PCI术后MACE的早期预警和个体化治疗的重要依据。
Objective To explore the predictive value of morphology-voltage-P-wave duration(MVP)score on major adverse cardiovascular events(MACE)in patients with myocardial infarction after percutaneous coronary intervention(PCI).Methods 90 patients with myocardial infarction who visited the hospital from February 2021 to August 2024 were selected.Based on whether they experienced MACE within 6 months after PCI,the patients were divided into MACE group(26 cases)and non MACE group(64 ca-ses).The general data,electrocardiogram indicators[lead I P-wave voltage(PVLⅠ),inferior wall lead P-wave morphology(PWM)and P-wave duration(PWD),electrocardiogram MVP score,ST segment el-evation(STE),corrected QT interval(cQT),corrected QT interval dispersion(cQTd),corrected Tp-e interval(cTP-e)]of the 2 groups were compared and analyzed.The ratio of Tp-e interval to QT interval(Tp-e/QT)and the levels of cardiac function indicators such as left ventricular ejection fraction(LVEF)and left atrial anterior posterior diameter(LAD).The relationship between MVP score and MACE was analyzed using the Cox regression analysis model.The predictive ability was evaluated by the receiver op-erating characteristic(ROC)curve.The correlation was analyzed by the locally weighted regression scatter smoothing(Lowess)curve.The subgroup forest plot was used to explore the influencing factors.Results Com-pared with the non-MACE group,the scores of LAD,PWD,PVLⅠ,PWM,MVP and the levels of STE,cQTd,cTp-e and Tp-e/QT in MACE group were significantly higher,while the level of LVEF was lower.The incidence of MACE after PCI was 69.23%,which was higher(P<0.05).Multivariate Cox propor-tional hazard model analysis showed that with the increase of MVP score,the risk of MACE wasincreased 54.2%(HR=1.542,95%CI:1.287~1.641,P<0.05).ROC curve showed that MVP score exhibited the highest predictive ability for the occurrence of MACE within 6 months after operation compared with PWD,PVLⅠand PWM score,and its Area under curve(AUC)was 0.835(95%CI:0.678~0.922,P<0.05).Lowess curve showed that MVP score was positively correlated with MACE within 6 months after operation.Subgroup analysis showed that MVP score was more correlated with the incidence of postopera-tive MACE in the subgroups of LAD≥38.45 mm,LVEF<63.17%,STE≥82.54 uV and CQTD≥43.55 ms.Conclusion The electrocardiogram MVP score is an independent predictor of MACE occurrence within 6 months after PCI in patients with myocardial infarction,and its predictive ability is significantly better than that of a single P-wave parameter.The MVP score is positively correlated with the risk of MACE,and the correlation is higher in the high LAD,STE,cQTd and low LVEF subgroups,providing important evidence for early warning and personalized treatment of MACE after PCI.
作者
方梦根
章富军
高华良
FANG Menggen;ZHANG Fujun;GAO Hualiang(Department of Electrophysiology,Chizhou Second People's Hospital,Chizhou Anhui 247100,China)
出处
《新疆医科大学学报》
2025年第7期943-949,956,共8页
Journal of Xinjiang Medical University
基金
安徽省卫生健康应用医学科研项目(AH202105137)。
关键词
MVP评分
心肌梗死
经皮冠状动脉介入治疗
不良心血管事件
morphology-voltage-P-wave duration(MVP)score
myocardial infarct
percutaneous coronary intervention(PCI)
adverse cardiovascular events
