左室压力-应变环技术预测急性ST段抬高型心肌梗死患者直接PCI术后早期左室重构  

Left ventricular remodeling risk predicted by left ventricular pressure-strain loop technology in patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention

作　　者：刘晓丹[1] 王飞[1] 刘艳红 张杰 林海伦 赖玉琼[1] LIU Xiaodan;WANG Fei;LIU Yanhong;ZHANG Jie;LIN Hailun;LAI Yuqiong(Department of Cardiac Function Examination,The First People’s Hospital of Foshan,Foshan,Guangdong 528000,China)

机构地区：[1]佛山市第一人民医院心脏功能检查科,广东佛山528000

出　　处：《影像研究与医学应用》2024年第15期10-15,共6页Journal of Imaging Research and Medical Applications

基　　金：佛山市卫生健康局自筹经费类医学科研课题(20220051)。

摘　　要：目的:探讨左室压力-应变环技术对ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PCI)术后早期左室重构(LVR)的预测价值。方法:收集2021年10月—2022年7月佛山市第一人民医院心血管重症监护室行直接PCI术的102例STEMI患者,根据术后3个月左室收缩末期容积(LVESV)是否增大≥15%分为重构组(n=42)与非重构组(n=60)。收集患者的一般资料,术后48h、术后1个月、术后3个月对患者进行常规二维超声心动图检查(2D-TTE)、左室纵向应变(LVGLS)及心肌做功参数检查,心肌做功参数包括整体做功指数(GWI)、整体有用功(GCW)、整体无用功(GWW)、整体做功效率(GWE),比较两组间以上参数的差异。结果:两组术后48h各参数比较,差异无统计学意义(P>0.05),术后1个月、术后3个月重构组的左室舒张末期内径(LVEDD)、左室舒张末期容积(LVEDV)、LVESV高于非重构组,左室射血分数(LVEF)低于非重构组,术后3个月重构组的左房内径高于非重构组,差异有统计学意义(均P<0.05),余参数差异无统计学意义(P>0.05)。术后48h,术后1个月、术后3个月重构组LVGLS、GWE、GWI、GCW低于非重构组,差异有统计学意义(均P<0.05),GWW高于非重构组,但仅术后1个月的差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,术后48 h GWI≤1307 mmHg%及术后1个月GWE≤88%是行直接PCI术后的STEMI患者出现LVR的独立危险因素(P<0.05)。结论:术后48h GWI≤1307mmHg%和术后1个月GWE≤88%是STEMI患者行直接PCI术后早期出现LVR的独立危险因素。Objective To assess the predictive value of left ventricular pressure-strain loop technique for early left ventricular remodeling in patients with ST-segment elevation myocardial infarction(STEMI)after primary percutaneous coronary intervention(PCI).Methods A total of 102 STEMI patients who underwent PCI from October 2021 to July 2022 admitted to Cardiovascular Intensive Care Unit of The First People’s Hospital of Foshan were prospectively included.Patients were divided into a remodeling group(42 cases)and a non-remodeling group(60 cases)based on whether the left ventricular end-diastolic volume increased by≥15%at three months post-operatively.Patient baseline characteristics were collected.Routine two-dimensional transthoracic echocardiography(2D-TTE),left ventricular global longitudinal strain(LVGLS),and myocardial work parameters including global work index(GWI),global constructive work(GCW),global wasted work(GWW),and global work efficiency(GWE)were examined at 48 hours,one month,and three months after PCI.Differences in these parameters between the two groups were compared.Results There was no statistically significant difference in baseline characteristics between the remodeling and non-remodeling groups(all P>0.05).There was no significant difference in 2D-TTE parameters between the two groups at 48 hours after operation(P>0.05),while left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV)in the remodeling group were higher than those in the non-remodeling group at one month and three months after operation,left ventricular ejection fraction(LVEF)was lower in the remodeling group than it in the non-remodeling group(all P<0.05).LVGLS,GWE,GWI,and GCW in the remodeling group were lower than those in the non-remodeling group at 48 hours,one month and three months after operation(all P<0.05).Multivariate Logistic regression analysis showed that GWI≤1307 mmHg%at 48 hours after PCI and GWE≤88%at one month after PCI were independent risk factors for left ventricular remodel

关 键 词：急性ST段抬高型心肌梗死 左室压力-应变环 心肌做功 左心室重构 经皮冠状动脉介入治疗 

分 类 号：R445.1[医药卫生—影像医学与核医学]