心肌声学造影对急性前壁STEMI血运重建患者的预后评估价值  

Prognostic value of myocardial contrast echocardiography in patients with acute anterior STEMI revascularization

作　　者：林玉萍[1] 黄锦杭 张海林 李盛[1] 卫展扬[1] LIN Yu-ping;HUANG Jin-hang;ZHANG Hai-lin;LI Sheng;WEI Zhan-yang(Department of Cardiovascular Medicine,Dongguan People's Hospital,Dongguan,Guangdong,523000,China)

机构地区：[1]东莞市人民医院心血管内科,广东东莞523000 [2]东莞市人民医院超声科,广东东莞523000

出　　处：《心血管康复医学杂志》2025年第2期194-198,共5页Chinese Journal of Cardiovascular Rehabilitation Medicine

基　　金：2020年东莞市社会科技发展(一般)项目(202050715001535)。

摘　　要：目的:本研究旨在探讨心肌声学造影在急性前壁ST段抬高型心肌梗死(STEMI)血运重建患者预后评估中的价值。方法:纳入东莞市人民医院2019年7月1日-2021年10月1日期间收治的234例行经皮冠状动脉介入治疗(PCI)并完成心肌声学造影的急性前壁STEMI患者。根据6个月内是否发生主要不良心血管事件(MACE)分为无MACE组(188例)与MACE组(46例)。对比两组患者一般资料、心肌声学造影指标。采用多因素Logistic回归分析急性前壁STEMI患者PCI术后发生MACE的影响因素,受试者工作特征(ROC)曲线分析心肌声学造影指标对急性前壁STEMI患者PCI术后发生MACE的预测价值。结果:与无MACE组比较,MACE组既往心肌梗死比例、D-二聚体、C反应蛋白、B型利钠肽、肌酸激酶同工酶(CK-MB)峰值、T波倒置发生率均显著增加,ST段回落幅度显著增大(P<0.05或<0.01)。心肌声学造影结果显示,与无MACE组比较,MACE组左室射血分数(LVEF)[(52.54±7.66)%比(55.98±10.04)%]显著降低,室壁运动评分指数(WMSI)[(1.22±0.13)比(1.17±0.15)]、造影剂评分指数(CSI)[(1.54±0.32)%比(1.16±0.21)%]显著升高(P<0.05或<0.01)。多因素Logistic回归分析显示,既往心肌梗死、C反应蛋白、CSI、T波倒置是急性前壁STEMI患者PCI术后发生MACE的独立危险因素(OR=13.790~6601.747,P<0.05或<0.01)。ROC曲线显示,CSI对急性前壁STEMI患者PCI术后发生MACE具有较好的预测价值,曲线下面积(AUC)值为0.874(95%CI 0.825~0.914),最佳截断值为1.33%。结论:心肌声学造影对急性前壁STEMI血运重建患者的预后评估有重要意义。Objective:This study aimed to investigate the value of myocardial contrast echocardiography(MCE)in the prognostic assessment of patients undergoing revascularization for acute anterior ST-segment elevation myocardial infarction(STEMI).Methods:A total of 234 patients with acute anterior STEMI who underwent percutaneous coronary intervention(PCI)and completed MCE admitted in Dongguan People's Hospital between July 1 st 2019 and October 1 st 2021 were included.According to presence of major adverse cardiovascular events(MACE)during 6 months,patients were divided into no MACE group(n=188)and MACE group(n=46).General data and MCE indexes were compared between the two groups.Multivariate Logistic regression analysis was employed to analyze influencing factors for MACE in patients with acute anterior STEMI after PCI.Receiver operating characteristic(ROC)curve was applied to analyze predictive value of MCE indexes for MACE in patients with acute anterior STEMI after PCI.Results:Compared with patients in no MACE group,those in MACE group had significant higher proportion of previous myocardial infarction,D-dimer,C reactive protein,B-type natriuretic peptide,creatine kinase isoenzyme MB(CK-MB),incidence of T-wave inversion and ST-segment resolution amplitude(P<0.05 or<0.01).MCE showed that compared with those in no MACE group,those in MACE group had significant lower left ventricular ejection fraction(LVEF)[(52.54±7.66)%vs.(55.98±10.04)%],and significant higher wall motion score index(WMSI)[(1.22±0.13)vs.(1.17±0.15)]and contrast score index(CSI)[(1.54±0.32)%vs.(1.16±0.21)%](P<0.05 or<0.01).Multivariate Logistic regression analysis revealed that previous myocardial infarction,C-reactive protein,CSI and T-wave inversion were independent risk factors for MACE in patients with acute anterior STEMI after PCI(OR=13.790~6601.747,P<0.05 or<0.01).ROC curve indicated that CSI had good predictive value for MACE in patients with acute anterior STEMI after PCI,the area under curve(AUC)was 0.874(95%CI 0.825~0.914)and optimal cutof

关 键 词：前壁心肌梗死 血管成形术 气囊 冠状动脉 心肌血管重建术 

分 类 号：R541.22[医药卫生—心血管疾病]