摘要
目的 探讨左室整体纵向应变(LVGLS)联合全球急性冠状动脉事件注册(GRACE)评分预测急诊经皮冠状动脉介入治疗(PCI)术后急性心肌梗死(AMI)患者发生冠状动脉微循环障碍(CMD)的临床价值。方法 选取收治的AMI患者90例为研究对象(失访10例,图像质量差筛除4例),最终纳入76例。术后48 h,患者接受左室心肌声学造影(MCE)技术检测。将患者根据冠状动脉微循环灌注情况分为非CMD组(n=53)及CMD组(n=23)。分析比较2组临床数据及超声心动图相关数据。采用多因素Logistic回归分析筛选CMD发生的影响因素,并绘制受试者工作特征(ROC)曲线分析其临床预测价值。结果 76例患者中,发生CMD 23例(30.26%)。CMD组的LVGLS、GRACE评分高于非CMD组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,LVGLS、GRACE评分是急诊PCI术后AMI患者发生CMD的独立预测因子。LVGLS预测CMD发生的曲线下面积为0.858(95%CI:0.769~0.948)。LVGLS联合GRACE评分预测CMD发生的曲线下面积为0.891(95%CI:0.815~0.967)。结论 LVGLS是早期评估急诊PCI术后AMI患者CMD发生的独立预测因素,其协同GRACE评分可以提高预测CMD发生的准确性。
Objective To investigate the clinical value of left ventricular global longitudinal strain(LVGLS) combined with the global register of acute coronary events(GRACE) score in predicting coronary microcirculation disorder(CMD) in patients with acute myocardial infarction(AMI) after emergency percutaneous coronary intervention(PCI).Methods A total of 90 patients with AMI were selected as the study objects(10 cases were lost in follow-up,4 cases were screened for poor image quality),and 76 cases were finally included.Left ventricular myocardial contrast echocardiography(MCE) was performed in patients at 48 h after surgery.Patients were divided into non-CMD group(n=53) and CMD group(n=23) according to coronary microcirculation perfusion.Clinical data and echocardiographic data of the two groups were analyzed and compared.Multivariate Logistic regression analysis was used to screen the influencing factors of CMD occurrence,and receiver operating characteristic(ROC) curve was drawn to analyze its clinical predictive value.Results Of the 76 patients,23(30.3%) cases had CMD.LVGLS and GRACE scores in the CMD group were higher than those in the non-CMD group,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that LVGLS and GRACE score were independent predictors of CMD in AMI patients after emergency PCI.The area under the curve of CMD predicted by LVGLS was 0.858(95%CI,0.769 to 0.948).LVGLS combined with GRACE predicted that the area under the curve for CMD was 0.891(95%CI,0.815 to 0.967).Conclusion LVGLS is an independent predictor for early assessment of CMD occurrence in AMI patients after emergency PCI,and its combination with GRACE score can improve the accuracy of predicting CMD occurrence.
作者
王莉
吴春苑
匡龙
宋佳贤
任骋
徐芳
WANG Li;WU Chunyuan;KUANG Long;SONG Jiaxian;REN Cheng;XU Fang(Department of Cardiovascular Medicine,Zhangjiagang Hospital Affiliated to Soochow University,Zhangjiagang,Jiangsu,215600)
出处
《实用临床医药杂志》
CAS
2024年第3期39-44,50,共7页
Journal of Clinical Medicine in Practice
基金
江苏省苏州市指导性项目(SYSD2018004)
江苏省张家港市科技计划项目(ZKYL2341)。
关键词
左室整体纵向应变
心肌声学造影
全球急性冠状动脉事件注册
急性心肌梗死
冠状动脉微循环障碍
left ventricular global longitudinal strain
myocardial contrast echocardiography
global register of acute coronary events
acute myocardial infarction
coronary microcirculation disorder
