四维自动左室定量分析技术预测急性心肌梗死患者经皮冠脉介入术后心脏不良事件发生风险的价值  

Value of four-dimensional automatic left ventricular quantitative analysis technology in predicting the risk of adverse cardiac events in patients with acute myocardial infarction after percutaneous coronary intervention

作　　者：张春霞 张银丽[2] 崔智飞 ZHANG Chun-xia;ZHANG Yin-li;CUI Zhi-fei(Department of Ultrasound Medicine,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450000,Henan,CHINA;Department of Ultrasound Medicine,the Third People's Hospital of Zhengzhou,Zhengzhou 450000,Henan,CHINA)

机构地区：[1]郑州大学附属郑州中心医院超声医学科,河南郑州450000 [2]郑州市第三人民医院超声医学科,河南郑州450000

出　　处：《海南医学》2025年第3期402-407,共6页Hainan Medical Journal

基　　金：2023年度河南省医学科技攻关计划联合共建项目(编号:LHGJ20232785)。

摘　　要：目的探讨四维自动左室定量分析技术(4D-LVQ)预测急性心肌梗死(AMI)患者经皮冠脉介入(PCI)术后心脏不良事件(MACE)发生风险的价值。方法采用前瞻性队列研究的方法,选取2022年6月至2023年6月郑州大学附属郑州中心医院1000例拟行PCI术的AMI患者作为研究对象,根据术后6个月内是否发生MACE分为MACE组和N-MACE组。比较两组患者的一般资料、常规超声参数[左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左心室射血分数(LVEF)]和4D-LVQ相关参数[左室整体收缩期峰值纵向应变(GLS)、环向应变(GCS)、面积应变值(GAS)、径向应变(GRS)],采用Logistic回归方程分析AMI患者PCI术后MACE发生的影响因素,绘制受试者工作特征(ROC)曲线分析4D-LVQ相关参数单一及联合预测MACE发生的价值。结果术后6个月内共有40例失访,50例发生MACE,发生率为5.21%;MACE组患者的LVEF、GRS分别为(44.34±2.01)%、26.64±7.18,明显低于N-MACE组的(48.84±3.46)%、33.55±9.46,GRACE评分、LVEDV、LVESV、GLS、GCS、GAS、糖尿病所占比例分别为(140.11±14.50)分、(100.11±10.34)mL、(63.65±8.13)mL、-11.34±3.34、-16.30±4.88、-21.13±6.28、36.00%,高于N-MACE组的(113.41±12.49)分、(88.13±9.95)mL、(55.42±5.57)mL、-15.18±4.17、-20.44±4.76、-28.28±7.34、16.59%,差异均有统计学意义(P<0.05);Logistic回归方程分析结果显示,GLS、GCS、GAS、GRS、糖尿病均是AMI患者PCI术后MACE发生影响因素(P<0.05);ROC分析结果显示,4D-LVQ相关参数联合预测MACE发生的曲线下面积(AUC)为0.916,特异性及敏感性分别为89.34%、82.00%,优于各参数单一预测价值及常规超声参数联合预测价值(P<0.05)。结论4D-LVQ技术对AMI患者PCI术后是否发生MACE具有良好预测价值,有助于指导临床诊治,具有临床应用价值。Objective To explore the value of four-dimensional automatic left ventricular quantitative analysis(4D-LVQ)in predicting the risk of major adverse cardiac events(MACE)in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods Using a prospective cohort study method,1000 AMI patients scheduled for PCI surgery at Zhengzhou Central Hospital Affiliated to Zhengzhou University from June 2022 to June 2023 were selected and divided into the MACE group and the N-MACE group based on whether MACE occurred within 6 months after surgery.The general information,routine ultrasound parameters(left ventricular end-diastolic volume[LVEDV],left ventricular end-systolic volume[LVESV],left ventricular ejection fraction[LVEF]),and 4D-LVQ related parameters(global left ventricular systolic peak longitudinal strain[GLS],global circumferential strain[GCS],global area strain value[GAS],and global radial strain[GRS])were compared between the two groups.Logistic regression equation was used to analyze the influencing factors of MACE occurrence in patients with AMI after PCI.Receiver operating characteristic(ROC)curve was plotted to analyze the predictive value of single and combined use of 4D-LVQ related parameters for predicting MACE occurrence.Results Within 6 months after surgery,a total of 40 patients were lost to follow-up,and 50 patients experienced MACE,with an incidence rate of 5.21%.The LVEF and GRS of patients in the MACE group were(44.34±2.01)%and 26.64±7.18,respectively,which were lower than(48.84±3.46)%and 33.55±9.46 of the N-MACE group;the GRACE score,LVEDV,LVESV,GLS,GCS,GAS,and the proportion of patients with diabetes were(140.11±14.50)points,(100.11±10.34)mL,(63.65±8.13)mL,-11.34±3.34,-16.30±4.88,-21.13±6.28,and 36.00,which was significantly higher than(113.41±12.49)points,(88.13±9.95)mL,(55.42±5.57)mL,-15.18±4.17,-20.44±4.76,-28.28±7.34,and 16.59%in the N-MACE group;the differences were statistically significant(P<0.05).Logistic regression equation indicates that

关 键 词：急性心肌梗死 经皮冠脉介入术 心脏不良事件 四维自动左室定量分析技术 

分 类 号：R542.22[医药卫生—心血管疾病]