急性心肌梗死血运重建后冠状动脉微循环障碍对患者住院期间急性左心衰竭的预测价值  

Predictive value of coronary microcirculation dysfunction after revascularization in patients with acute myocardial infarction for acute heart failure during hospitalization

作　　者：王岚[1] 马玉良[1] 王伟民[1] 朱天刚[1] 靳文英[1] 赵红[1] 曹成富[1] 王静[1] 姜柏林[2] WANG Lan;MA Yuliang;WANG Weimin;ZHU Tiangang;JIN Wenying;ZHAO Hong;CAO Chengfu;WANG Jing;JIANG Bailin(Department of Cardiology,Peking University People’s Hospital,Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction,Center for Cardiovascular Translational Research,Beijing 100044,China;Department of Anesthesiology,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院心血管内科,急性心肌梗死早期预警和干预北京市重点实验室,心血管转化医学研究中心,北京100044 [2]北京大学人民医院麻醉科,北京100044

出　　处：《北京大学学报(医学版)》2025年第2期267-271,共5页Journal of Peking University:Health Sciences

基　　金：首都卫生发展科研专项(新)(首发2020-1-4031)。

摘　　要：目的:评估已行血运重建的急性心肌梗死(acute myocardial infarction,AMI)患者冠状动脉微循环障碍(coronary microcirculation dysfunction,CMD)的发生情况、临床特点,以及CMD对患者住院期间发生急性左心衰竭的预测价值。方法:回顾性入选2015年11月至2021年7月北京大学人民医院因AMI住院,已行经皮冠状动脉介入术(percutaneous coronary intervention,PCI)完成罪犯血管血运重建,并于住院期间完成心肌声学造影(myocardial contrast echocardiography,MCE)的患者145例,根据MCE结果分为CMD组及冠状动脉微循环正常组。收集两组患者的临床资料及MCE资料,比较两组患者住院期间急性左心衰竭的发生率。应用二元Logistic回归分析校正混杂因素,探讨CMD患者发生急性左心衰竭的风险,绘制受试者工作特征(receiver operating characteristic,ROC)曲线,评估CMD对患者住院期间急性左心衰竭的预测价值。结果:145例已行PCI的AMI患者中有87例(60%)存在CMD。与正常组相比,CMD组患者肌钙蛋白I(troponin I,TnI)峰值更高[52.8(8.1,84.0)μg/L vs.18.9(5.7,56.1)μg/L,P=0.005],Killip分级更差(P=0.030),罪犯血管分布不同(P<0.001),且罪犯血管PCI术前心肌梗死溶栓(thrombolysis in myocardial infarction,TIMI)血流<3级者更多(65.1%vs.43.1%,P=0.025)。MCE结果显示,与正常组相比,CMD组患者左心室射血分数(left ventricular ejection fraction,LVEF)、整体长轴应变(global longitudinal strain,GLS)及室壁运动计分指数(wall motion score index,WMSI)更差(P均<0.001)。CMD组患者住院期间发生急性左心衰竭的比例显著高于正常组(13.8%vs.1.7%,P=0.013),校正罪犯血管分布、罪犯血管术前TIMI血流及TnI峰值后,CMD组患者急性左心衰竭的风险依旧升高(OR=9.120,95%CI:1.152~72.192,P=0.036)。CMD预测已行血运重建的AMI患者住院期间急性左心衰竭的ROC曲线下面积(area under curve,AUC)为0.677(95%CI:0.551~0.804,P=0.035)。结论:AMI患者PCI术后依然有60%存在MCE检�Objective:To study incident and clinical characteristics of the coronary microcirculation dysfunction(CMD)in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI)by myocardial contrast echocardiography(MCE)and to explore the predictive value of CMD for in-hospital acute heart failure event.Methods:One hundred and forty five patients with AMI who had received PCI and completed MCE during hospitalization in Peking University People’s Hospital from November 2015 to July 2021 were enrolled in our study.The patients were divided into CMD group and normal group according to the coronary microcirculation status detected by MCE.Clinical data and MCE data of the two groups were collected and analyzed.The acute heart failure event during hospitalization was described.A multivariate Logistic regression model was built to analyze the risk of acute heart failure in patients with CMD.A receiver operating characteristic(ROC)curve was drawn to evaluate the value of CMD in predicting acute heart failure event.Results:CMD detected by MCE occurred in 87 patients(60%).Compared with normal group,patients with CMD had higher troponin I(TnI)peak level[52.8(8.1,84.0)μg/L vs.18.9(5.7,56.1)μg/L,P=0.005],poorer Killip grade on admission(P=0.030),different culprit vessel(P<0.001)and more patients had thrombolysis in myocardial infarction(TIMI)flow pre-PCI less than grade 3 in culprit vessel(65.1%vs.43.1%,P=0.025).Meanwhile,patients with CMD had poorer left ventricular ejection fraction(LVEF)[52%(43%,58%)vs.61%(54%,66%)],poorer global longitudinal strain(GLS)[-11.2%(-8.7%,-14.0%)vs.-13.9%(-10.8%,-17.0%)]and worse wall motion score index(WMSI)(1.58±0.36 vs.1.25±0.24)(P all<0.001).Acute left heart failure happened in 13.8%of the CMD patients,which were significant higher than that in the patients with normal coronary microcirculation perfusion(1.7%,P=0.013).After correcting for the culprit vessel,the TIMI flow pre-PCI in the culprit vessel and the peak TnI value,the risk of acute left heart failure i

关 键 词：心肌梗死 心肌声学造影 冠状动脉微循环障碍 心力衰竭 

分 类 号：R542.22[医药卫生—心血管疾病]