右心室心肌自动功能成像对冠状动脉旁路移植术后短期不良事件的风险预测价值  

Value of automatic functional imaging of right ventricular myocardium in predicting risk of short-term adverse events after coronary artery bypass grafting

作　　者：陈思骄 刘娅妮[2] 张艺[1] Sijiao Chen;Yani Liu;Yi Zhang(Department of Medical Ultrasound,Central Hospital of Wuhan,Huazhong University of Science and Technology,Wuhan 430014,China;Department of Medical Ultrasound,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学附属武汉市中心医院超声诊断科,武汉430014 [2]华中科技大学附属同济医院超声诊断科,武汉430030

出　　处：《中华医学超声杂志（电子版）》2024年第2期114-120,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：湖北陈孝平科技发展基金会青年科学专项基金(CXPJJH122001-2237)。

摘　　要：目的应用心肌自动功能成像(AFI)评估冠状动脉旁路移植术(CABG)患者术前右心室功能,探讨其在CABG患者术后短期不良事件风险预测中的价值。方法选取2019年12月至2021年12月在华中科技大学同济医学院附属同济医院和武汉市中心医院接受CABG的患者104例,应用常规超声心动图和AFI分别测量左、右心室心功能参数。根据患者术后30 d内是否发生不良事件将其分为不良事件组38例和未发生不良事件组66例。比较2组间一般资料、常规超声心动图参数和AFI参数。采用ROC曲线分析超声参数对不良事件发生的预测效能。应用Logistic回归分析影响CABG患者预后的独立危险因素。结果不良事件组左心室射血分数(LVEF)、左心室整体纵向应变(LVGLS)、右心室游离壁应变(RVFWLS)和四腔心右心室纵向应变(RV4CLS)均低于未发生不良事件组(P<0.05),不良事件组右心室心肌功能指数(RVMPI)高于未发生不良事件组(P<0.05)。ROC曲线分析结果显示,RVFWLS>-21%预测不良事件的敏感度为74%,特异度为76%,ROC曲线下面积为0.77,RV4CLS>-17.7%的敏感度为61%,特异度为71%,ROC曲线下面积为0.69。二元Logistic回归分析显示RVFWLS(OR值:8.8,P<0.01)、RV4CLS(OR值:3.8,P<0.01)、LVGLS(OR值:2.5,P=0.04)、RVMPI(OR值:4.5,P<0.01)、慢性肾病(OR值:4.2,P<0.01)、NYHA分级(OR值:3.0,P=0.01)和EuroScore评分(OR值:2.3,P=0.04)是影响CABG预后的独立危险因素。结论右心室自动心肌功能成像能够提供快速、准确、可靠的参数信息预测CABG围手术期风险,RVFWLS和RV4CLS对患者预后具有良好的预测价值。同时临床指标参数作为CABG患者短期不良事件的危险因素不容忽视。Objective To measure preoperative right ventricular function in patients with coronary artery bypass grafting(CABG)by automatic functional imaging(AFI),and to evaluate its value in predicting the risk of short-term adverse events after CABG.Methods A total of 104 patients who received CABG at Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology and Wuhan Central Hospital from December 2019 to December 2021 were selected to measure left and right ventricular cardiac function parameters by routine echocardiography and AFI,respectively.The patients were divided into an adverse event group(38 cases)or a no adverse event group(66 cases)according to whether adverse events occurred within 30 days after surgery.General data,conventional echocardiographic parameters,and AFI parameters were compared between the two groups.Receiver operating characteristic(ROC)curve analysis was performed to assess the predictive efficiency of ultrasonic parameters for adverse events.Binary logistic regression was used to identify the independent risk factors affecting the prognosis of patients with CABG.Results Left ventricular ejection fraction(LVEF),left ventricular global longitudinal strain(LVGLS),right ventricular free wall strain(RVFWLS),and four-chamber right ventricular longitudinal strain(RV4CLS)in the adverse event group were lower than those of the no adverse event group(P<0.05).Right ventricular myocardial function index(RVMPI)in the adverse event group was higher than that of the group without adverse event(P<0.05).ROC curve analysis showed that the area under the ROC curve of RVFWLS was 0.77,with a sensitivity of 74%and specificity of 76%(P<0.05);the area under the ROC curve of RV4CLS was 0.69,with a sensitivity of 61%and specificity of 71%(P<0.05).Binary logistic regression analysis showed that RVFWLS(odds ratio[OR]:8.8,P<0.01),RV4CLS(OR:3.8,P<0.01),LVGLS(OR:2.5,P=0.04),RVMPI(OR:4.5,P<0.01),chronic kidney disease(OR:4.2,P<0.01),NYHA grade(OR:3.0,P=0.01),and EuroScore(OR:2.3,P=0.04)were indepen

关 键 词：冠状动脉旁路移植术 右心室功能 斑点追踪成像 自动功能成像 

分 类 号：R541.4[医药卫生—心血管疾病]