摘要
目的探讨心肌声学造影(MCE)对急性心肌梗死患者存活心肌及经皮冠状动脉介入(PCI)术后临床预后的评估价值。方法回顾性选取2021年10月至2023年1月自贡市第四人民医院100例急性心肌梗死患者临床资料。根据急性心肌梗死患者PCI术后6个月内是否发生主要不良心血管事件(MACE)分为预后不良组21例和预后良好组79例。以患者PCI术后3个月超声心动图左心室壁运动改善为“金标准”,统计MCE检测存活心肌结果,比较两组临床资料、心功能指标和MCE定量参数。Spearman相关性分析MCE定量参数、心功能指标与存活心肌节段数的相关性;Pearson相关性分析MCE定量参数与心功能指标的相关性。Logistic回归分析MCE定量参数与急性心肌梗死患者PCI术后临床预后的关系。绘制ROC曲线评价MCE定量参数对急性心肌梗死患者PCI术后临床预后的预测价值。结果MCE判定急性心肌梗死患者存活心肌的敏感度及特异度分别为92.55%、90.91%,准确率为91.97%。预后不良组患者存活心肌节段<4个比例高于预后良好组,PCI术后3个月心功能指标左心室射血分数(LVEF)和左心室短轴缩短率(LVFS)低于预后良好组(χ2/t=4.571、2.883、2.948,P<0.05);预后不良组患者PCI术后3个月MCE定量参数峰值强度(A)、曲线斜率(β)、心肌血流量(A·β)低于预后良好组,灌注计分指数(PSI)高于预后良好组(t=3.077、2.393、3.831、2.989,P<0.05);急性心肌梗死患者A、β、A·β、LVEF、LVFS与存活心肌节段数呈正相关,PSI与存活心肌节段数呈负相关(r=0.652、0.609、0.667、0.685、0.647、-0.627,P<0.01);急性心肌梗死患者PCI术后3个月PSI与LVEF、LVFS呈负相关,A、β、A·β与LVFS、LVEF呈正相关(r=-0.801、-0.662、0.705、0.781、0.752、0.727、0.593、0.654,P<0.05);Logistic回归分析显示急性心肌梗死患者PCI术后3个月A、β、A·β、PSI均与急性心肌梗死患者PCI术后临床预后相关(OR=4.322、3.672、6.670、0.648,P<0.01);PCI术后3个月MCE定量参数A、β、A·β、PSI均可预测急性心肌梗死患者PCI术后的临床预后,四者联合预测的曲线下面积为0.945,预测效能高于各参数单独预测。结论MCE检查可评价急性心肌梗死患者的存活心肌,定量参数A、β、A·β、PSI对急性心肌梗死患者PCI术后的临床预后有较好的预测效能。
Objective To investigate the assessment value of myocardial contrast echocardiography(MCE)for viable myocardium and clinical prognosis in patients with acute myocardial infarction(AMI)after percutaneous oronary intervention(PCI).Methods Clinical data of 100 AMI patients from October 2021 to January 2023 at the Fourth People's Hospital of Zigong City were retrospectively selected.Patients with major adverse cardiovascular events(MACE)within 6 months after PCI were included in the poor prognosis group(21 cases),while those without MACE were included in the good prognosis group(79 cases).Using echocardiography improvement of left ventricular regional wall motion abnormality as the gold standard,the results of MCE detecting viable myocardium were recorded.The clinical data,cardiac function indexes and MCE quantitative parameters were compared between the two groups.Spearman correlation analysis was performed to assess the correlation between MCE quantitative parameters,cardiac function indicators,and the segments of viable myocardium.Pearson correlation analysis was used to examine the relationship between MCE quantitative parameters and cardiac function indicators.Logistic regression analysis was conducted to determine the relationship between MCE quantitative parameters and clinical prognosis in AMI patients after PCI.ROC curve was used to evaluate the predictive value of MCE quantitative parameters for prognosis in patients with AMI after PCI.Results The sensitivity,specificity,and accuracy of MCE in determining the viable myocardium in AMI patients were 92.55%,90.91%,and 91.97%,respectively.The proportion of patients with less than 4 segments of viable myocardium in the poor prognosis group was higher than that in the good prognosis group,the cardiac function indicators including left ventricular ejection fraction(LVEF)and left ventricular fractional shortening(LVFS)3 months post-operation were lower in the poor prognosis group compared to the good prognosis group(χ2/t=4.571,2.883,2.948;P<0.05).The MCE quantitative parameters of peak intensity(A),curve slope(β),and myocardial blood flow(A·β)in the poor prognosis group were lower than those in the good prognosis group,while the perfusion score index(PSI)was higher than that in the good prognosis group(t=3.077,2.393,3.831,2.989;P<0.05).A,β,A·β,LVEF and LVFS in AMI patients were positively correlated with the segments of viable myocardium,while PSI was negatively correlated(r=0.652,0.609,0.667,0.685,0.647,-0.627;P<0.01).Three months after PCI,PSI in AMI patients was negatively correlated with LVEF and LVFS,while A,β,and A·βwere positively correlated with LVFS and LVEF(r=-0.801,-0.662,0.705,0.781,0.752,0.727,0.593,0.654;P<0.05).Logistic regression analysis showed that A,β,A·β,and PSI at 3 months post-PCI were all associated with clinical prognosis of AMI patients after PCI(OR=4.322,3.672,6.670,0.648;P<0.01).MCE quantitative parameters A,β,A·β,and PSI at 3 months post-PCI could predict the prognosis of AMI patients.The area under the curve of the combined prediction is 0.945,and the prediction efficiency was higher than that of each parameter alone.Conclusion MCE can evaluate the myocardial viability in AMI patients,and the quantitative parameters A,β,A·β,and PSI are effective in predicting the prognosis of AMI patients after PCI.
作者
汤勇
罗裕
颜艳
帅文欢
马敏
Tang Yong;Luo Yu;Yan Yan;Shuai Wenhuan;Ma Min(Department of Cardiology,Fourth People's Hospital of Zigong City,Zigong 6430001,China;Department of Ultrasound,Fourth People's Hospital of Zigong City,Zigong 6430001,China;Department of Cardiology,Sixth People's Hospital of Chengdu,Chengdu 610000,China)
出处
《心脑血管病防治》
2024年第9期9-14,共6页
CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT
基金
2020年四川省医学(青年创新)科研课题项目(Q20061)。
关键词
急性心肌梗死
经皮冠状动脉介入
存活心肌
心肌声学造影
临床预后
Acute myocardial infarction
Percutaneous coronary intervention
Viable myocardium
Myocardial contrast echocardiography
Clinical prognosis
