左室心肌做功与STEMI患者急诊PCI术后出现左室重构的相关性研究  

Correlation analysis of left ventricular global myocardial work and left ventricular remodeling after emergency PCI in patients with ST-segment elevation myocardial infarction

作　　者：徐芳 徐俊杰 王莉 任骋[1] 钱雪松 宋佳贤 XU Fang;XU Junjie;WANG Li;REN Cheng;QIAN Xuesong;SONG Jiaxian(Department of Cardiology,Zhangjiagang First People's Hospital/Zhangjiagang Hospital Affiliated to Suzhou University,Zhangjiagang 215600,China;Department of Emergency,Zhangjiagang First People's Hospital/Zhangjiagang Hospital Affiliated to Suzhou University,Zhangjiagang 215600,China)

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,江苏张家港215600

出　　处：《东南大学学报（医学版）》2024年第1期78-84,共7页Journal of Southeast University(Medical Science Edition)

基　　金：张家港科技局项目(ZKS2024)。

摘　　要：目的:探讨左室心肌做功与急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠脉介入术(PCI术)后出现左室重构的相关性。方法:自2019年1月到2020年12月连续纳入行急诊PCI术后的54例STEMI患者[男45例,(59.7±12.4)岁],分别在术后48 h以及术后6个月行常规心超、斑点追踪超声以及左室心肌做功检查,测得常规心超数据、左室纵向应变和左室心肌做功各指标,以术后6个月左室舒张末期容积增大≥15%作为左室重构的标准,探讨左室心肌做功与左室重构的相关性。结果:17例患者在术后6个月出现左室重构,左室重构患者组48 h的左室整体做功指数明显低于左室无重构组[(1099.7±426.1)mmHg%vs.(1582.3±557.6)mmHg%,P=0.003]。多因素回归分析显示,48 h左室整体做功指数是行急诊PCI术后的STEMI患者出现左室重构的独立危险因素。ROC曲线下面积为0.757(95%CI为0.622~0.891,截点为1382 mmHg%,特异度为64.9%,敏感度为82.4%,P=0.035)。结论:48 h左室整体做功指数是行急诊PCI术后STEMI患者出现左室重构的独立危险因素。Objective:To explore the correlation analysis of left ventricular global myocardial work(LVGMW)and left ventricular remodeling(LVR)after emergency percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods:From January 2019 to December 2020,54 consecutive patients(45 males)who underwent emergency PCI for AMI were included with an average age of(59.7±12.4)years old.Comprehensive echocardiography was performed for patients who underwent emergency PCI for STEMI 48 hours(48 h)and 6 months after PCI.Left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV),left ventricular global longitudinal strain(LVGLS)and left ventricular global work indices(LVGWI)were assessed.Left ventricle(LV)remodeling(LVR)was defined as an increase of 15%of LVEDV from 48 hours to 6 months after surgery.Multivariate Logistic regression analysis was used to evaluate the correlation of LVGMW and LVR.Results:Left ventricular remodeling occurred in 17 patients at 6 months after surgery.48 h left ventricular global work index(LVGWI)in the LVR group was significantly lower than that in non-LVR group[(1099.7±426.1)mmHg%vs.(1582.3±557.6)mmHg%,P=0.003].Multivariate Logistic regression analysis showed that LVGWI within 48 h was an independent risk factor for LVR after emergency PCI in STEMI patients,the area under ROC curve was 0.757(95%CI 0.622-0.891,cut-off point 1382 mmHg%,specificity 64.9%,sensitivity 82.4%,P=0.035).Conclusion:Lower 48 h LVGWI was an independent risk factor for LVR in STEMI patients undergoing emergency PCI.

关 键 词：左室心肌做功 左室整体做功指数 急性ST段抬高型心肌梗死 经皮冠脉介入术 左室重构 

分 类 号：R542.22[医药卫生—心血管疾病]