基于超声心动图参数预测非ST段抬高型急性冠脉综合征患者预后:一项回顾性队列研究  

Predicting prognosis of non-ST segment elevation acute coronary syndrome patients based on echocardiographic parameters:A retrospective cohort study

作　　者：罗婷婷 田伟帆 孙芹 张海宏[1] 万智[1] LUO Tingting;TIAN Weifan;SUN Qin;ZHANG Haihong;WAN Zhi(Department of Emergency,West China Hospital,Sichuan University,Chengdu,610041,China)

机构地区：[1]四川大学华西医院急诊科,成都610041

出　　处：《临床急诊杂志》2025年第3期196-202,共7页Journal of Clinical Emergency

摘　　要：目的:探索超声心动图参数对于非ST段抬高型急性冠状动脉综合征(non-ST segment elevation acute coronary syndrome,NSTE-ACS)患者长期预后的预测能力。方法:本研究为回顾性研究,纳入对象为2020年3月1日—2023年3月31日就诊于我院急诊科、明确诊断为NSTE-ACS的患者847例。根据随访结果,将纳入患者分为存活组(717例)和死亡组(130例)。收集患者一般情况、实验室指标、就诊后首次超声心动图参数等临床数据,采用logistic回归方法分析基于超声心动图参数的NSTE-ACS患者全因死亡的独立危险因素。结果:847例NSTE-ACS患者中男641例(75.7%),平均年龄(66±12)岁;非ST段抬高型心肌梗死488例(57.6%),不稳定型心绞痛359例(42.4%)。中位随访时间2.5(1.8,2.9)年。存活组和死亡组患者左心室内径、左心房内径、右心房内径、舒张晚期二尖瓣环速度、舒张早期二尖瓣前向血流速度、舒张早期二尖瓣环速度、舒张早期二尖瓣前向血流速度/舒张早期二尖瓣环速度、左心室射血分数和室壁运动欠协调比例差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,左心房内径(OR=1.049,95%CI 1.017~1.082,P=0.002)、右心房内径(OR=1.040,95%CI 1.006~1.075,P=0.020)、舒张早期二尖瓣前向血流速度(OR=3.206,95%CI 1.512~6.798,P=0.002)、舒张早期二尖瓣环速度(OR=0.878,95%CI 0.776~0.993,P=0.038)、左心室射血分数<50%(OR=2.841,95%CI 1.697~4.757,P<0.001)是NSTE-ACS患者长期全因死亡的独立危险因素。结论:左心房内径、右心房内径、舒张早期二尖瓣前向血流速度、舒张早期二尖瓣环速度和左心室射血分数<50%是NSTE-ACS患者长期全因死亡的独立危险因素,基于超声心动图参数可有效预测NSTE-ACS患者的长期预后。Objective To explore the predictive ability of echocardiographic parameters for long-term prognosis in patients with non-ST segment elevation acute coronary syndrome(NSTE-ACS).Methods This study is a retrospective cohort study,including 847 patients diagnosed with NSTE-ACS who visited the Emergency Department of our hospital from March 1,2020 to March 31,2023.According to follow-up results,patients were divided into a survival group(717 cases)and a death group(130 cases).Clinical data,including general information,laboratory indicators,and echocardiographic parameters were collected,and logistic regression was used to analyze the independent risk factors for all-cause mortality in NSTE-ACS patients based on echocardiographic parameters.Results Among 847 NSTE-ACS patients,there were 641 males(75.7%),with an average age of(66±12)years old.There were 488 cases(57.6%)of non-ST segment elevation myocardial infarction and 359 cases(42.4%)of unstable angina.The median follow-up time was 2.5(1.8,2.9)years.Significant differences were observed in the left ventricular diameter,the left atrial diameter,the right atrial diameter,the late diastolic mitral annular velocity,the early diastolic transmitral flow velocity,the early diastolic mitral annular velocity,the early diastolic transmitral flow velocity/the early diastolic mitral annular velocity,the left ventricular ejection fraction and the proportion of ventricular wall movement incoordination between the survival group and the death group(P<0.05).Multiple logistic regression analysis showed that,the left atrial diameter(OR=1.049,95%CI 1.017-1.082,P=0.002),the right atrial diameter(OR=1.040,95%CI 1.006-1.075,P=0.020),the early diastolic transmitral flow velocity(OR=3.206,95%CI 1.512-6.798,P=0.002),the early diastolic mitral annular velocity(OR=0.878,95%CI 0.776-0.993,P=0.038)and the left ventricular ejection fraction<50%(OR=2.841,95%CI 1.697-4.757,P<0.001)were independent risk factors for long-term all-cause mortality in NSTE-ACS patients.Conclusion The left atrial diam

关 键 词：非ST段抬高型急性冠脉综合征 超声心动图 预后 

分 类 号：R541.4[医药卫生—心血管疾病]