急性心肌梗死患者左心室重构与冠状动脉微循环及预后的相关性  

Correlation between Left Ventricular Remodeling and Coronary Microcirculation and Prognosis in Patients with Acute Myocardial Infarction

作　　者：陈逸敏 李光 谢桂庭 林艳[3] 余冰艳 董豪坚 CHEN Yimin;LI Guang;XIE Guiting;LIN Yan;YU Bingyan;DONG Haojian(Medical College of Shantou University,Shantou,Guangdong 515041,China;Boluo People's Hospital,Huizhou,Guangdong 516100,China;Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences),South China Medical University,Guangzhou 510080,China;Huizhou Central Hospital,Huizhou,Guangdong 516100,China)

机构地区：[1]汕头大学医学院,广东汕头515041 [2]博罗县人民医院,广东惠州516100 [3]南方医科大学附属广东省人民医院(广东省医学科学院),广州510080 [4]惠州市中心医院,广东惠州516100

出　　处：《岭南心血管病杂志》2024年第2期129-134,共6页South China Journal of Cardiovascular Diseases

基　　金：急诊再灌注治疗策略优化研究(项目编号:2016YFC1301202)。

摘　　要：目的在急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)且行直接经皮冠状动脉介入(primary percutaneous coronary intervention,pPCI)治疗患者中研究以左心室质量指数(left ventricular mass index,LVMI)为代表的左心室重构与以冠状动脉(冠脉)造影微循环阻力指数(angio-IMR,AMR)为代表的微循环障碍及预后的关系。方法本研究是回顾性病例对照研究,纳入2018年3月至2020年12月于广东省人民医院、广东省人民医院珠海分院和2021年11月至2022年1月于博罗县人民医院确诊STEMI且行pPCI治疗的患者,在术后及3个月后分别行超声心动图检查,计算患者LVMI变化百分比,根据LVMI变化量是否>20%分为高左心室重构组(n=62)、低左心室重构组(n=99)。通过对比两组的一般情况、冠脉微循环指标及预后情况,评价其之间的相关性及结局变量。结果(1)高左心室重构组比低左心室重构组AMR更高(287±89 vs.247±56,P=0.006),冠脉血流速度(coronary flow velocity,CFV)更慢(14.6±5.8 vs.16.6±5.3,P<0.05),预后更差(33.8%vs.13.1%,P=0.003)。LVMI绝对变化量与AMR呈正相关、线性关系(r=0.169,P=0.032)。无复流仅存在于高左心室重构组[3(4.8%)vs.0,P=0.027]。(2)Logistic回归分析表明AMR是LVMI变化量大于20%的危险因素(OR=1.008,P=0.001)。AMR是左心室重构的独立预测因子。受试者工作特征曲线(receiver operating characteristic curve,ROC)分析AMR切点为268.5。结论STEMI患者行pPCI治疗以LVMI为代表的左心室重构与以AMR为代表的冠脉微循环有明确关系,左心室重构变化越大,AMR越大,预后更差。Objectives To investigate the relationship between left ventricular remodeling and coronary microcirculation in patients with acute ST-segment elevation myocardial infarction(STEMI)who received primary percutaneous coronary intervention(pPCI).The relationship between left ventricular remodeling represented by left ventricular mass index(LVMI)and microcirculation disturbance represented by coronary angiography microcirculation resistance index(AMR)with prognosis were analyzed.Methods This study was a retrospective study.Patients with STEMI and pPCI treatment in Guangdong Provincial Hospital,Guangdong Provincial Hospital Zhuhai Hospital from March 2018 to December 2020 and in Boluo People's Hospital from November 2021 to January 2022 were included and underwent cardiac color Doppler ultrasound respectively after surgery and 3 months later to calculate the percentage change in LVMI.Patients were divided into higher left ventricular remodeling group(n=62)and lower left ventricular remodeling group(n=99)according to whether the LVMI change was>20%.The correlation and outcome variables were evaluated by comparing the general situation,coronary microcirculation indicators and prognosis of the two groups.Results(1)Higher left ventricular remodeling group had higher AMR(287±89 vs.247±56,P=0.006),slower coronary flow velocity(CFV)rate(14.6±5.8 vs.16.6±5.3,P<0.05)and worse prognosis(33.8%vs.13.1%,P=0.003)than lower left ventricular remodeling group.The absolute change of LVMI was positively and linearly correlated with AMR(r=0.169,P=0.032).No reflow existed only in higher left ventricular remodeling group[3(4.8%)vs.0,P=0.02].(2)Logistics regression analysis showed that AMR was a risk factor for LVMI variation greater than 20%(OR=1.008,P=0.001).AMR was an independent predictor of left ventricular remodeling.The cut-off point of AMR for receiver operating characteristic curve(ROC)analysis was 268.5.Conclusions In STEMI patients undergoing pPCI,left ventricular remodeling represented by LVMI is clearly correlated with coro

关 键 词：左心室质量指数 急性心肌梗死 冠状动脉造影微循环阻力指数 冠状动脉微循环 左心室重构 

分 类 号：R542.22[医药卫生—心血管疾病]