多模态影像学技术对急性ST段抬高型心肌梗死患者PCI术后左室重构的预测价值  

Multimodal imaging in predicting left ventricular remodeling after PPCI in patients with acute ST-segment elevation myocardial infarction

作　　者：陈思 陈允安 张洁[2] 周莹[3] 李明珠 刘琨[4] CHEN Si;CHEN Yun'an;ZHANG Jie;ZHOU Ying;LI Mingzhu;LIU Kun(Postgraduate Training Base of First People's Hospital of Lianyungang,Jinzhou Medical University,Liangyungang,Jiangsu 222000,China;不详)

机构地区：[1]锦州医科大学连云港市第一人民医院研究生培养基地,江苏连云港222000 [2]连云港市第一人民医院超声科,江苏连云港222000 [3]连云港市第一人民医院影像科,江苏连云港222000 [4]连云港市第一人民医院心内科,江苏连云港222000

出　　处：《中国临床研究》2024年第6期854-860,共7页Chinese Journal of Clinical Research

基　　金：连云港市卫生科技项目(202009)。

摘　　要：目的探讨三维斑点追踪超声心动图(3D-STE)、心肌做功(MW)及心脏磁共振(CMR)晚期钆增强(LGE)对急性ST段抬高型心肌梗死(STEMI)后左室重构(LVR)的预测价值。方法选取2022年8月至2023年8月于连云港市第一人民医院住院的77例行急诊经皮冠状动脉介入治疗(PPCI)的急性STEMI患者,于术后24 h内行常规经胸超声心动图(TTE)、3D-STE、MW检查,测定左室整体纵向、径向、圆周、面积应变(GLS、GRS、GCS、GAS)及整体做功指数(GWI)、整体有效功(GCW)、整体无效功(GWW)、整体做功效率(GWE),术后7 d内完善CMR-LGE检查,并于术后3个月复查TTE、3D-STE及MW,定义左室舒张末期容积(LVEDV)增加≥20%为心肌梗死后LVR。分析各指标对STEMI后LVR的预测价值。结果按照LVR金标准分组,LVR组18例(23.4%),非LVR组59例(76.6%)。LVR组TTE-左室射血分数(LVEF)、GWI、GCW、GWE、GLS、GRS、GCS、GAS低于非LVR组(P<0.05),TTE-LVESV、GWW高于非LVR组(P<0.05)。CMR-LGE中LVR组梗死面积(IS)较非LVR组大(P<0.05),CMR-LVEF较非LVR组低(P<0.05)。术后3个月随访,LVR组GWI、GCW、GWE、GLS、GRS、TTE-LVEF低于非LVR组(P<0.05);多因素logistic回归和RDC分析显示,CMR-IS、GWI、GLS、GAS为LVR的独立预测指标(P<0.01),其AUC值分别为0.815、0.806、0.775和0.734。结论3D-STI及MW有助于预测STEMI患者PPCI术后LVR,尤其GLS及GWI,其价值相似,且不劣于CMR-IS。Objective To investigate the predictive value of three-dimensional speckle tracking echocardiography(3D-STE),myocardial work(MW),and late gadolinium enhancement cardiac magnetic resonance(CMR-LGE)in left ventricular remodeling(LVR)after acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 77 patients with STEMI who underwent primary percutaneous coronary intervention(PPCI)from August 2022 to August 2023 in Lianyungang First People's Hospital were enrolled.All patients underwent routine transthoracic echocardiography(TTE),3D-STE,and MW within 24 hours after surgery.The left ventricular parameters including global longitudinal strain(GLS),global radial strain(GRS),global circumferential strain(GCS),global area strain(GAS),global work index(GWI),global effective work(GCW),global wasted work(GWW),and global work efficiency(GWE)were measured.CMR-LGE was performed within 7 days after surgery,and TTE,3D-STE,and MW were repeated at 3 months after surgery.The increase left ventricular end-diastolic volume(LVEDV)≥20%was defined as LVR after myocardial infarction.The predictive value of each index for LVR after myocardial infraction(MI)was analyzed.Results According to the LVR gold standard,there were 18 cases in the LVR group(23.4%)and 59 cases in the non-LVR group(76.6%).Compared with the non-LVR group,TTE-LVEF,GWI,GCW,GWE,GLS,GRS,GCS,GAS decreased,TTE-LVESV and GWW increased,infarct size(IS)increased and CMR-LVEF decreased in the LVR group.At 3 months follow up after PPCI,the LVR group had lower GWI,GCW,GWE,GLS,GRS,TTE-LVEF than the non-LVR group(P<0.05).Multivariate logistic regression and ROC analysis showed that CMR-IS,GWI,GLS and GAS were independent predictors of LVR(P<0.01),and their AUC were 0.815,0.806,0.775,0.734,respectively.Conclusion 3D-STE and MW are helpful in predicting LVR after PPCI in STEMI patients,especially GLS and GWI,which are similar in value and not inferior to CMR-IS.

关 键 词：急性ST段抬高型心肌梗死 左室重构 三维斑点追踪超声心动图 心肌做功 心脏磁共振 晚期钆增强成像 

分 类 号：R543.3[医药卫生—心血管疾病] R445[医药卫生—内科学]