多模态影像对STEMI患者急诊PCI术后MACE的预测价值  

The predictvalue of multimodal imaging for MACE in STEMI patients after primary PCI

作　　者：陈思 陈允安 张洁[3] 周莹[4] 李明珠 龚晓璇[5] 刘琨[2] CHEN Si;CHEN Yun’an;ZHANG Jie;ZHOU Ying;LI Mingzhu;GONG Xiaoxuan;LIU Kun(First People’s Hospital of Lianyungang Graduate Training Base of Jinzhou Medical University,Lianyungang 222000;Department of Cardiology,the First People’s Hospital of Lianyungang,Lianyungang 222000;Department of Ultrasound,the First People’s Hospital of Lianyungang,Lianyungang 222000;Department of Imaging,the First People’s Hospital of Lianyungang,Lianyungang 222000;Department of Cardiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]锦州医科大学研究生培养基地,江苏连云港222000 [2]连云港市第一人民医院心内科,江苏连云港222000 [3]连云港市第一人民医院超声科,江苏连云港222000 [4]连云港市第一人民医院影像科,江苏连云港222000 [5]南京医科大学第一附属医院心内科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2024年第11期1525-1533,1549,共10页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏省卫生健康委医学科研项目(M2022025);南京医科大学第一附属医院青年基金培育计划(PY2022009)。

摘　　要：目的:探讨三维斑点追踪超声心动图(three-dimensional speckle tracking echocardiography,3D-STE)、心肌做功(myo-cardial work,MW)对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者急诊经皮冠状动脉介入治疗(primary percutaneous coronary intervention,PPCI)术后主要不良心血管事件(major adverse cardiovascular event,MACE)发生的预测价值。方法:纳入90例行PPCI的首次STEMI患者,术后24 h内行3D-STE、MW检查,术后7 d内完善心脏磁共振晚期钆增强成像(cardiac magnetic resonance late gadolinium enhancement imaging,CMR-LGE)检查,随访12个月MACE(再发心绞痛、因急性冠脉综合征行血运重建、急性心衰发作、心源性猝死)的发生情况。结果:20例(22.2%)患者发生MACE,单因素及多因素Cox回归分析显示梗死面积(infarction size,IS)、整体纵向应变(global longitudinal strain,GLS)、整体做功指数(global work index,GWI)为预测MACE发生的独立参数,受试者工作特征(receiver operating characteristic,ROC)曲线显示上述指标的曲线下面积(area under the curve,AUC)分别为0.886、0.846、0.830,Delong法两两比较显示AUC值差异无统计学意义(P均>0.05)。联合GLS和GWI预测MACE发生的AUC值达0.939,显著优于GLS及GWI单一参数(P均<0.05),且与IS相当(P>0.05)。Kaplan-Meier曲线表明GLS<-10.5%、GWI>1298.5 mmHg%、IS<26.05%的患者有更高的生存率(P<0.05)。结论:3D-STE及MW能较好地预测STEMI患者PPCI术后MACE的发生,其中GLS及GWI诊断价值相似,二者联合优于单一指标,且与IS诊断效能相当。Objective:To investigate the predictive value of three-dimensional speckle tracking echocardiography(3D-STE)and myocardial work(MW)on major adverse cardiovascular events(MACE)in patients with acute ST-segment elevation myocardial infarction(STEMI)who underwent primary percutaneous coronary intervention(PPCI).Methods:Ninety patients with first concurrence of STEMI and treated with PPCI were enrolled.3D-STE,MW assessments were performed within 24 hours following PPCI,and cardiac magnetic resonance late gadolinium enhancement imaging(CMR-LGE)was completed within 7 days post-procedure.The patients were followed up for 12 months after PPCI to track the occurrence of MACE,which inclueded recurrent angina pectoris,revascularization due to acute coronary syndrome,acute heart failure attack,and sudden cardiac death.Results:Twenty patients(22.2%)experienced MACE.Univariate and multivariate COX regression analysis showed infarction size(IS),global longitudinal strain(GLS),and global work index(GWI)as independent predictors of MACEs.The area under the curve(AUC)values for these indicators from the receiver operating characteristic(ROC)curves were 0.886,0.846 and 0.830,respectively,and pairwise comparison by Delong method showed no statistically significant difference in AUC values(all P>0.05).The AUC value of the combined GLS and GWI in predicting MACE was 0.939,which was significantly better than either parameter alone(P<0.05),and comparable to IS(P>0.05).Kaplan-Meier curve showed that patients with GLS<-10.5%,GWI>1298.5 mmHg% and IS<26.05% had higher survival rate(P<0.05).Conclusion:3D-STEand MW can better predict MACE after PPCI inSTEMI patients.GLS and GWI have similar diagnostic value,and their combination provides superior predictive power compared to either parameter alone,and is comparable to IS in terms of diagnostic efficiency.

关 键 词：急性ST段抬高型心肌梗死 主要不良心血管事件 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：R542.22[医药卫生—心血管疾病]