左室心肌做功对急性心肌梗死患者急诊PCI术后MACE发生的预测价值  

Predictive value of left ventricular global myocardial work on MACE occurrence after emergency PCI in patients with acute myocardial infarction

作　　者：徐芳 徐俊杰 吴春苑 匡龙 宋佳贤 李海刚 钱雪松 王莉 XU Fang;XU Junjie;WU Chunyuan;KUANG Long;SONG Jiaxian;LI Haigang;QIAN Xuesong;WANG Li(Department of Cardiology,Zhangjiagang Hospital Affiliated to Suzhou University,Zhangjiagang First People's Hospital,Zhangjiagang,Jiangsu,China;.Department of Emergency,Zhangjiagang Hospital Affiliated to Suzhou University,Zhangjiagang First People's Hospital)

机构地区：[1]苏州大学附属张家港医院(张家港市第一人民医院)心血管内科,江苏张家港215600 [2]苏州大学附属张家港医院(张家港市第一人民医院)急诊科

出　　处：《临床心血管病杂志》2022年第12期960-966,共7页Journal of Clinical Cardiology

基　　金：苏州市科技计划项目(No:SYSD2018004);张家港科技计划项目(No:ZKS2024、ZKS1821)。

摘　　要：目的应用左室心肌做功(LVGMW)预测急诊经皮冠状动脉介入术(PCI)后的急性心肌梗死(AMI)患者主要不良心脏事件(MACE)的价值。方法连续选取2019年1月—2020年12月因AMI行急诊PCI的患者73例,男62例,女11例,平均年龄(59.8±11.8)岁,分别在术后48 h内及术后6个月行常规心脏超声、斑点追踪超声(STE)以及LVGMW检查,检测左室射血分数(LVEF)、左室纵向应变(LVGLS)和LVGMW等;平均随访时间9个月,随访期间观察患者是否发生心力衰竭、恶性心律失常、心绞痛、心肌梗死、死亡等MACE,分析LVGMW对MACE的预测价值。结果随访期间30例患者发生MACE,其中心力衰竭18例、心绞痛12例。MACE组48 h内的左室整体做功效率(LVGWE)明显低于无MACE组[(83.8±11.4)%vs.(91.4±7.3)%,P=0.002];多因素logistic回归分析结果显示,48 h内LVGWE预测AMI患者急诊PCI术后发生MACE的ROC曲线下面积为0.736(95%CI:0.620~0.852,截点为93.5%,敏感度为80.0%,特异度为59.5%,P=0.001)。结论48 h内的LVGWE是AMI患者急诊PCI术MACE发生的独立预测因子。Objective To explore the predictive value of left ventricular global myocardial work(LVGMW)on major adverse cardiac events(MACE)after emergency percutaneous coronary intervention(PCI)in patients with acute myocardial infarction(AMI).Methods From January 2019 to December 2020,73 consecutive patients(62 males)who underwent emergency PCI for AMI were included with an average age of(59.8±11.8)years old.Conventional cardiac ultrasound and speck tracing ultrasound(STE)were performed within 48 hours and 6 months after PCI,respectively,to detect left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV),longitudinal strain(GLS),and LVGMW.The mean follow-up time was 9 months.During the follow-up period,MACE such as heart failure,malignant arrhythmia,angina pectoris,myocardial infarction,and death were observed.The predictive value of LVGMW on MACE was analyzed.Results During the follow-up period,MACE occurred in 30 patients,heart failure in 18 patients and angina pectoris in 12 patients.LVGWE within 48 hours in the MACE group was significantly lower than that in non-MACE group[(83.8±11.4)%vs.(91.4±7.3)%,P=0.002].Multivariate logistic regression analysis showed that LVGWE within 48 hours predicted the area under ROC curve of MACE after emergency PCI in AMI patients were 0.736(95%CI:0.620—0.852,cut-off point 93.5%,sensitivity 80.0%,specificity 59.5%,P=0.001).Conclusion Lower LVGWE within 48 hours was an independent predictor of MACE in AMI patients undergoing emergency PCI.

关 键 词：左室心肌做功 左室整体做功效率 急性心肌梗死 急诊经皮冠状动脉介入术 主要不良心脏事件 

分 类 号：R542.2[医药卫生—心血管疾病]