无创心肌做功成像技术预测ST段抬高型心肌梗死患者经皮冠状动脉介入术后短期左室重构的应用价值  

Clinical application of non-invasive myocardial work imaging in ST-segment elevation myocardial infarction patients with left ventricular remodeling after percutaneous coronary intervention

作　　者：杨雪 马全瑞[2] 徐艳萍 王英 曹伟 丛广志[3] 郝钰 纳丽莎 Yang Xue;Ma Quanrui;Xu Yanping;Wang Ying;Cao Wei;Cong Guangzhi;Hao Yu;Na Lisha(Department of Cardiac Function Examination of Heart Centre,General Hospital of Ningxia Medical University,Yinchuan 750004,China;School of Basic Medicine,Ningxia Medical University,Yinchuan 750004,China;Cardiovascular Medicine,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院心脏中心功能检查部超声心动图室,银川750004 [2]宁夏医科大学基础学院,银川750004 [3]宁夏医科大学总医院心血管内科,银川750004

出　　处：《中华超声影像学杂志》2023年第6期493-500,共8页Chinese Journal of Ultrasonography

基　　金：宁夏回族自治区重点研发计划项目(2021BEG03063)。

摘　　要：目的探究术后不同时间点无创心肌做功成像技术对ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术后短期左室重构的评估价值。方法前瞻性收集2021年10月至2022年7月在宁夏医科大学总医院行PCI术的126例STEMI患者,根据术后3个月有无左室重构分为重构组(34例)与非重构组(92例)。收集患者的一般资料,术前、术后1周、术后1个月、术后3个月对患者进行常规超声心动图检查和无创心肌做功成像,比较两组间以上参数的差异。采用Pearson相关分析法分析各指标间的相关性。采用Logistic回归分析确定预测STEMI术后左室重构的独立危险因素,并获得预测模型,采用ROC曲线评估该模型的诊断价值。结果①一般资料比较:两组间体质指数(BMI)、收缩压、舒张压、植入支架数、高脂血症史差异有统计学意义(均P<0.05),余参数差异无统计学意义(均P>0.05)。术前和术后1周两组常规二维经胸超声心动图(2D-TTE)参数和无创心肌做功(MW)参数比较差异无统计学意义(均P>0.05)。②2D-TTE参数比较:术后3个月重构组左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)显著高于非重构组,左心室射血分数(LVEF)、舒张早期速度/舒张晚期速度(E/A)显著低于非重构组,差异有统计学意义(均P<0.05),余参数差异无统计学意义(均P>0.05)。③无创心肌做功(MW)参数比较:术后1个月、术后3个月重构组整体纵向应变(GLS)、整体做功效率(GWE)、整体做功指数(GWI)、整体有用功(GCW)低于非重构组,整体无用功(GWW)高于非重构组,差异有统计学意义(均P<0.001)。④相关性分析:术后1个月GLS、GWE、GCW、GWI与LVEDV均呈负相关(r=-0.42、-0.38、-0.50、-0.53,均P<0.001),GWW与LVEDV均呈正相关(r=0.45,P<0.001)。⑤Logistic回归分析:术后1个月GLS<17%、GCW<1900 mmHg%、GWW>105 mmHg%、GWE<90 mmHg%是STEMI患者PCI术后左室重构的独立预测因子(均P<0.05),预测模型为Logit(P)=Objective To explore the application value of non-invasive myocardial work imaging in evaluating the cardiac function of ST-segment elevation myocardial infarction(STEMI)patients with left ventricular remodeling(LVR)after percutaneous coronary intervention(PCI).Methods One hundred and twenty-six patients with STEMI undergoing PCI in General Hospital of Ningxia Medical University from December 2021 to September 2022 were prospectively collected and divided into left ventricular remodeling group(LVR group,34 cases)and non left ventricular remodeling group(NLVR group,92 cases)according to whether there was left ventricular remodeling 3 months after surgery.General data were collected.Routine echocardiography and noninvasive myocardial work imaging were performed before,1 week,1 month,and 3 months after surgery,the differences in the above parameters between the two groups were compared.Pearson correlation analysis was used to analyze the correlation between the indicators.Logistic regression analysis was used to determine the independent risk factors of left ventricular remodeling after STEMI,and a predictive model was obtained.The diagnostic value of the model was judged by ROC curve.Results①General information comparison:There were statistically significant differences between the two groups in BMI,systolic blood pressure,diastolic blood pressure,average number of stents implanted,and history of hyperlipidemia(all P<0.05),but there was no significant difference in other data(all P>0.05).There was no statistically significant difference in two-dimensional transthoracic echocardiography(2D-TTE)parameters and non-invasive myocardial work(MW)parameters between the two groups before and 1 week after operation(both P>0.05).②2D-TTE parameter comparison:LVESV and LVEDV at 3 months after PCI in the LVR group were significantly higher than those in the NLVR group,and LVEF and E/A were significantly lower than those in the NLVR group(all P<0.05);There were no significant differences in other indexes between the two group

关 键 词：超声心动描记术 心肌做功 左室重构 ST段抬高型心肌梗死 左室压力-应变环 

分 类 号：R542.22[医药卫生—心血管疾病]