心脏超声三维空间面积应变参数对急性心肌梗死患者冠状动脉微循环障碍的评估及预测PCI治疗后心功能转归的价值  

Value of Three-Dimensional Spatial Area Strain Parameters of Cardiac Ultra⁃sound in Evaluating Coronary Microcirculatory Dysfunction in Patients with Acute Myocardial Infarction and Predicting Cardiac Functional Outcomes after PCI

作　　者：陈姣艳 郭丽焱[1] CHEN Jiaoyan;GUO Liyan(Department of Ultrasound Medicine,Linfen People′s Hospital,Linfen,Shanxi 041000,China)

机构地区：[1]临汾市人民医院超声医学科,山西临汾041000

出　　处：《岭南心血管病杂志》2025年第1期28-34,共7页South China Journal of Cardiovascular Diseases

基　　金：临汾市科学技术研究与开发项目(项目编号:临科技字[2021]18号)。

摘　　要：目的探讨心脏超声三维空间面积应变参数[面积应变不同步指数(area strain dyssynchrony index,ASDI)、整体面积应变(global area strain,GAS)、左心室整体长轴应变(global long-axis strain,GLS)]对急性心肌梗死(acute myocardial infarction,AMI)患者冠状动脉(冠脉)微循环障碍的评估价值,并分析各参数对其经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后心功能转归的预测价值。方法选取2022年1月至2023年1月临汾市人民医院126例AMI患者为研究对象,依据是否发生冠脉循环障碍将其分为微循环障碍组(n=101)和微循环正常组(n=25)。PCI治疗后1个月,依据美国纽约心脏协会(NYHA)心功能分级改善程度分为转归良好者、转归不良者。对比分析不同组别、不同心功能转归者ASDI、GAS、GLS变化,分析其对冠脉微循环障碍风险、心功能转归的影响。采用受试者工作特征曲线(receiver operating characteristic curve,ROC)及曲线下面积(area under the curve,AUC)评价ASDI、GAS、GLS对患者PCI治疗后心功能转归的预测效能。PCI治疗后随访3个月,统计主要不良心血管事件(major adverse cardiovascular events,MACE)发生情况,并分析ASDI、GAS、GLS不同水平变化患者的MACE发生率。结果微循环障碍组患者的GAS、GLS低于微循环正常组,ASDI高于微循环正常组,差异有统计学意义(P<0.05);GAS、GLS、ASDI高水平患者的冠脉微循环障碍发生风险分别为低水平的0.657倍、0.629倍、1.525倍(P<0.05);术前心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)血流分级及GAS、GLS、ASDI为PCI治疗后心功能转归的不良影响因素(P<0.05);GAS、GLS、ASDI联合预测PCI治疗后心功能转归不良的AUC高于单独指标预测(P<0.05);GAS、GLS高水平患者的MACE发生率低于低水平患者,而ASDI高水平患者的MACE发生率高于低水平患者,差异有统计学意义(P<0.05)。结论ASDI、GAS、GLS变化可用于评估AMI后冠脉微循环�Objectives To explore the evaluation value of cardiac ultrasound three-dimensional spatial area strain parameters[area strain dyssynchrony index(ASDI),global area strain(GAS),left ventricular global long-axis strain(GLS)]for coronary microcirculatory dysfunction in patients with acute myocardial infarction(AMI),and to analyze the predictive value of each parameter for cardiac function outcomes after percutaneous coronary intervention(PCI).Methods A total of 126 patients with AMI admitted to Linfen People′s Hospital from January 2022 to January 2023 were selected as the study subjects.They were categorized into two groups based on the presence or absence of coronary microcirculatory dysfunction:microcirculatory dysfunction group(n=101)and microcirculatory normal group(n=25).One month after PCI,patients were classified into good outcome group and poor outcome group based on the improvement degree of cardiac function classification according to the New York Heart Association(NYHA)classification.Comparative analysis was conducted on the changes in ASDI,GAS,and GLS among different groups and patients with different cardiac func⁃tion outcomes,and their impact on the risk of coronary microcirculatory dysfunction and cardiac function outcomes was analyzed.The receiver operating characteristic curve(ROC)and area under the curve(AUC)were used to evaluate the predictive efficacy of ASDI,GAS,and GLS for cardiac function outcomes after PCI.During the 3-month follow-up after PCI,the occurrence of major adverse cardiovascular events(MACE)was recorded,and the incidence of MACE among patients with different levels of changes in ASDI,GAS,and GLS was analyzed.Results The GAS and GLS of microcir⁃culation disorder group were significantly lower than those of normal microcirculation group,while ASDI was significantly higher than that of normal microcirculation group(P<0.05).The risk of coronary microcirculation disturbance in patients with high levels of GAS,GLS and ASDI was 0.657 times,0.629 times and 1.525 times of that with l

关 键 词：心肌梗死 冠状动脉微循环 血管成形术 经腔 经皮冠状动脉 心功能 转归 预测 主要不良心血管事件 

分 类 号：R542.22[医药卫生—心血管疾病]