摘要
目的探讨应用心脏超声造影测量肺渡越时间(PTT)评估急性ST段抬高型心肌梗死(STEMI)患者行经皮冠状动脉介入治疗(PCI)术后心功能不全的价值。方法前瞻性选取2023年9月至2024年9月在湖南省人民医院(晓庄学院附属第一医院)行PCI术的STEMI患者120例,根据指南分为心力衰竭(简称心衰)组(n=42)和非心衰组(n=78),比较两组一般临床资料、实验室参数及超声心动图参数之间的差异,分析PTT、标准化PTT(nPTT)与N末端B型利钠肽原(NT-proBNP)三者的诊断效能;并与美国纽约心脏病协会(NYHA)心功能分级进行一致性检验。结果与非心衰组相比,心衰组的NT-proBNP、PTT及nPTT数值显著增大(均P<0.05)。nPTT的ROC曲线下面积(AUC)为0.944,高于PTT、NT-proBNP(AUC=0.871、0.887)。采用K-means聚类按nPTT值将患者重新分四级后,nPTT分级与NYHA分级具有中等的一致性(Kappa=0.580,P<0.001),且行多组间比较不同NYHA分级间nPTT均能表现出差异性(P<0.05)。结论超声心功能评估指标PTT与NT-proBNP有相似的诊断效能,nPTT更优,且nPTT与NYHA分级有中等的一致性,并具有区分NYHA分级重叠的潜力,可为STEMI患者PCI术后心功能不全的评估提供新的客观依据。
ObjectiveTo explore the value of contrast-enhaoced echocardiography for measuring pulmonary transit time(PTT)in assessing heart failure after percutaneous coronary intervention(PCI)in acute ST-segment elevation myocardial infarction(STEMI)patients.MethodsFrom September 2023 to September 2024,120 patients with STEMI undergoing PCI at Hunan Provincial People's Hospital were prospectively selected and divided into a heart failure group(n=42)and a non-heart failure group(n=78)according to the guidelines.The differences in general clinical data,laboratory parameters,and echocardiographic parameters between the two groups were compared.The diagnostic efficacies of PTT,normalized PTT(nPTT),and N-terminal pro-B-type natriuretic peptide(NT-proBNP)were analyzed.Consistency between them and New York Heart Association(NYHA)heart function classification was tested.ResultsCompared to the non-heart failure group,the NT-proBNP,PTT,and nPTT values in the heart failure group were significantly increased(all P<0.05).The area under the curve(AUC)of nPTT was 0.944,better than that of PTT and NT-proBNP(AUC=0.871,0.887).After K-means clustering reclassified patients into four levels based on nPTT values,nPTT classification showed moderate consistency with NYHA classification(Kappa=0.580,P<0.001),and nPTT differed significantly across NYHA classifications(P<0.05).ConclusionsPTT,as an echocardiographic index for assessing cardiac function,has similar diagnostic efficacy to NT-proBNP,the nPTT is even better.It shows moderate consistency with the NYHA classification and holds potential for differentiating overlapping NYHA grades.Importantly,it offers a fresh objective way to evaluate cardiac dysfunction after PCI in STEMI patients.
作者
刘子琴
钟昕
胡勇军
游慧萍
谢旭
张宇涛
龙湘党
Liu Ziqin;Zhong Xin;Hu Yongjun;You Huiping;Xie Xu;Zhang Yutao;Long Xiangdang(Department of Ultrasound,Hunan Provincial People's Hospital(the First Affiliated Hospital of Hunan Normal University),Changsha 410005,China;Department of Cardiology,Hunan Provincial People's Hospital(the First Affiliated Hospital of Hunan Normal University),Changsha 410005,China)
出处
《中华超声影像学杂志》
北大核心
2025年第8期670-677,共8页
Chinese Journal of Ultrasonography
基金
湖南省临床医疗技术创新引导项目(2021SK50921)。
关键词
肺渡越时间
超声造影
心功能不全
急性ST段抬高型心肌梗死
心功能分级
Pulmonary transit time
Contrast-enhanced ultrasound
Cardiac insufficiency
ST-segment elevation myocardial infarction
Cardiac functional classification
