摘要
目的探究心肌运动定量(CMQ)分析技术参数对急性心肌梗死再灌注术后心肌微循环障碍的评估价值。方法选取急性心肌梗死患者60例,均于再灌注术后3~7 d行CMQ技术检查,根据患者是否合并心肌微循环障碍分为观察组(合并心肌微循环障碍,n=21)与对照组(未合并心肌微循环障碍,n=39),比较两组临床资料、左心功能指标[左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)及左心室舒张末期内径(LVEDD)]及CMQ技术参数[径向应变力(RS)、纵向应变力(LS)及环向应变力(CS)],分析CMQ技术参数与左心功能指标的相关性,评价CMQ技术参数对心肌微循环障碍的评估价值,比较两组不良心血管事件发生情况,并分析CMQ技术参数对心血管不良事件发生危险度的影响。结果观察组LVESD、LVEDD、LVEF及RS低于对照组,LS、CS高于对照组(P<0.05);急性心肌梗死患者CMQ技术参数RS与LVESD、LVEDD、LVEF呈正相关,LS、CS与LVESD、LVEDD、LVEF呈负相关(P<0.05);CMQ技术参数RS、LS、CS评估心肌微循环障碍的曲线下面积(AUC)分别为0.813、0.672、0.839,联合预测AUC为0.929,优于各指标单独评估;观察组术后3个月心血管不良事件发生率高于对照组(P<0.05);RS、LS、CS高水平者心血管不良事件发生危险度分别是低水平者的0.064倍、7.429倍、4.667倍。结论CMQ技术参数评估急性心肌梗死再灌注术后心肌微循环障碍,效能相对较高,且临床可通过RS、LS、CS值预测不良心血管事件风险,为后续治疗方案制定提供依据。
Objective To explore the evaluation value of myocardial motility quantitative(CMQ)analysis technical parameters for myocardial microcirculation disturbance after acute myocardial infarction and reperfusion.Methods 60 patients with acute myocardial infarction admitted from December 2019 to December 2021 were selected,all of whom underwent CMQ technique 3~7 d after reperfusion,and were divided into observation group(combined myocardial microcirculatory disorders,n=21)and control group(uncomplicated myocardial microcirculatory disorders,n=39)according to whether the patients were combined with myocardial microcirculatory disorders.The clinical data,left heart function indexes[left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)]and CMQ technical parameters[radial strain(RS),longitudinal strain(LS)and circumferential strain(CS)]were compared between the two groups,and the correlation between CMQ technical parameters and left heart function indexes was analyzed to evaluate the effect of CMQ.The correlation between CMQ technical parameters and left heart function indexes was analyzed to evaluate the value of CMQ technical parameters on the assessment of myocardial microcirculatory disorders,the adverse cardiovascular events in the two groups were compared,and the influence of CMQ technical parameters on the risk of adverse cardiovascular events was analyzed.Results LVESD,LVEDD,LVEF and RS in the observation group were lower than those in the control group,and LS and CS were higher than those in the control group,with statistically significant differences(P<0.05);CMQ technical parameters RS were positively correlated with LVESD,LVEDD and LVEF,and LS and CS were negatively correlated with LVESD,LVEDD and LVEF in patients with acute myocardial infarction(P<0.05).The AUCs of CMQ technical parameters RS,LS and CS for assessing myocardial microcirculatory disorders were 0.813,0.672 and 0.839,respectively,and the combined predicted AUC was 0.929,which was better than each index alone;the incidence of cardiovascular adverse events at 3 months after surgery was higher in the observation group than in the control group(P<0.05);the risk of cardiovascular adverse events for those with high levels of RS,LS and CS was higher than that for those with low levels,respectively.The risk of adverse cardiovascular events was 0.064,7.429 and 4.667 times higher in those with high levels of RS,LS and CS than in those with low levels,respectively.Conclusion CMQ technical parameters to assess myocardial microcirculatory impairment after reperfusion for acute myocardial infarction have relatively high efficacy,and the risk of adverse cardiovascular events can be predicted clinically by RS,LS,and CS values,which provide a basis for subsequent treatment planning.
作者
程景华
肖敏
苟加梅
CHENG Jinghua;XIAO Min;GOU Jiamei(Department of Ultrasound,the Sixth People's Hospital of Chengdu,Chengdu Sichuan 610051,China)
出处
《中国急救复苏与灾害医学杂志》
2023年第7期846-849,共4页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
2020年四川省医学会(青年创新)科研课题(编号:S20092)。
