三维斑点追踪成像评价右心室功能预测不稳定型心绞痛患者经PCI后不良事件  

Three-dimensional speckle tracking imaging in evaluation on right ventricular function for predicting adverse events in patients with unstable angina after PCI

作　　者：胡文姝 周畅[1] 徐亮[1] 孙恒 聂淑婷 邵袁缘 李心怡 HU Wenshu;ZHOU Chang;XU Liang;SUN Heng;NIE Shuting;SHAO Yuanyuan;LI Xinyi(Department of Ultrasound,Yichang Central People’s Hospital,the First College of Clinical MedicalScience,China Three Gorges University,Yichang 443003,China)

机构地区：[1]三峡大学第一临床医学院宜昌市中心人民医院超声科,湖北宜昌443003

出　　处：《中国介入影像与治疗学》2025年第2期102-106,共5页Chinese Journal of Interventional Imaging and Therapy

摘　　要：目的观察三维斑点追踪成像(3D-STI)评估不稳定型心绞痛(UA)患者右心室(RV)功能用于预测经皮冠状动脉介入治疗(PCI)后不良事件的价值。方法前瞻性纳入155例经3D-STI及常规超声心动图检查且拟接受PCI的UA患者,根据PCI后随访期间是否发生不良事件将其分为不良事件组(n=37)与对照组(n=118)。比较组间临床资料及超声心动图参数;以受试者工作特征曲线最大约登指数相应截断值为依据,将组间差异有统计学意义的3D-STI参数转化为新的二分类变量,分析UA经PCI后不良事件的独立预测因子,据以构建联合模型并评估其预测效能。结果不良事件组左心室舒张末期容积(LVEDV)高于,而左心室射血分数(LVEF)、右心室游离壁纵向应变(RVFWLS)及右心室整体纵向应变(RVGLS)均低于对照组(P均<0.05)。以单一LVEDV、RVFWLS及RVGLS区分有无不良事件的最佳截断值分别为110 ml、19.05%及19.75%,生成的3个二分类变量均为UA经PCI后发生不良事件的独立预测因子(P均<0.05),据以构建的联合模型预测UA经PCI后不良事件的曲线下面积为0.864。结论3D-STI参数RVFWLS<19.05%、RVGLS<19.75%及常规超声心动图参数LVEDV>110 ml均为UA患者经PCI后发生不良事件的独立预测因子。Objective To observe the value of three-dimensional speckle tracking imaging(3D-STI)in evaluation on right ventricle(RV)function for predicting adverse events in patients with unstable angina(UA)after percutaneous coronary intervention(PCI).Methods A total of 155 UA patients who underwent both 3D-STI and conventional echocardiography and planned to accept PCI were prospectively enrolled and divided into adverse event group(n=37)and control group(n=118)based on the occurrence of adverse events after PCI or not.Clinical data and echocardiographic parameters were compared between groups,and new binary variables were generated according to the optimal cut-off values showed by the maximum Youden index of receiver operating characteristic curves of 3D-STI parameters being statistically different between groups.Then the independent predictors of adverse events among UA patients after PCI were analyzed,a combined model was constructed,and its predictive value was assessed.Results In adverse event group,the left ventricular end diastolic volume(LVEDV)was higher,while the left ventricular ejection fraction(LVEF),right ventricular free wall longitudinal strain(RVFWLS)and right ventricular global longitudinal strain(RVGLS)were all lower than those in control group(all P<0.05).The optimal cut-off values for distinguishing adverse event or not was 110 ml for LVEDV,19.05%for RVFWLS and 19.75%for RVGLS,respectively,and all the 3 generated binary variables were independent predictors for adverse events of UA patients after PCI(all P<0.05).The area under the curve of combined model for predicting adverse events in UA patients after PCI was 0.864.Conclusion RVFWLS<19.05%and RVGLS<19.75%obtained with 3D-STI,as well as LVEDV>110 ml with conventional echocardiography were all independent predictors of adverse events in UA patients after PCI.

关 键 词：心绞痛 不稳定型 经皮冠状动脉介入治疗 心室功能 右 超声心动描记术 前瞻性研究 

分 类 号：R541.4[医药卫生—心血管疾病] R540.45[医药卫生—内科学]