摘要
目的探讨血管内超声(IVUS)结合二维斑点追踪(2D-STI)参数对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术后心肌损伤及主要不良心血管事件(MACE)的预测价值。方法纳入2017年1月至2020年12月邢台市中心医院接收的225例急性STEMI患者作为研究对象,均行PCI治疗。术后行IVUS和2D-STI等影像学检查,并测定心肌损伤的指标。通过Pearson方法对IVUS和2D-STI的测量值与心肌损伤指标之间的关联性进行分析。在12个月的随访期间,3例患者失访。根据是否发生MACE,患者被分为MACE组(n=43)和非MACE组(n=179)。通过单变量分析对STEMI患者的基本情况进行分析,利用logistic回归分析来识别MACE的影响因素。采用ROC曲线来评估IVUS和2D-STI参数预测MACE的诊断能力。结果225例急性STEMI患者肌酸激酶(CK-MB)的浓度测定值为(16.23±3.09)U/L,心肌肌钙蛋白(c Tn I)的水平为(0.36±0.05)ng/L。2D-STI的参数和最小管腔直径(MLD)、最小管腔面积(MLA)与CK-MB和c Tn I的浓度存在显著的负相关(P<0.05),而面积狭窄率(AS)的测量值则与这两种生化指标的浓度呈正相关(P<0.05)。进一步分析发现,MACE组AS值显著高于非MACE组,统计学上具有显著差异(P<0.05)。MACE组患者的MLD、MLA、整体圆周应变(CS)、整体径向应变(RS)和纵向应变(LS)值显著低于非MACE组患者。Logistic回归分析发现,MLA、AS、RS和LS是影响MACE发生的主要因素。ROC曲线进一步验证这些参数的预测价值。其中,MLA的临界值为3.56 mm~2,AS的为69.87%,RS的为29.87%,LS的为23.05%,其敏感度和特异度分别为69.77%与70.95%、81.40%与71.51%、60.47%与61.45%、86.05%与79.33%。AUC值显示,以上参数具有较好的区分能力,特别是LS的AUC值高达0.899(95%CI 0.799~0.999),而整体回归分析的敏感度和特异度达到95.35%和94.41%,AUC值为0.993(95%CI 0.979~1.000)。结论血管内超声和二维应变成像技术为急性STEMI患者心肌损伤评估提供精确的影像学支持,其相关量化指标在急性STEMI患者发生MACE时显示出显著的异常表达,上述指标因其与MACE的发生具有显著相关性,成为预测MACE风险的重要因子。
Objective To explore the predictive value of intravascular ultrasound(IVUS)combined with two-dimensional speckle tracking(2D-STI)parameters for myocardial injury and major adverse cardiovascular events(MACE)after percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 225 patients with acute STEMI admitted to Xingtai Central Hospital from January 2017 to December 2020 were included in the study and all underwent PCI.After the surgery,imaging examinations such as IVUS and 2D-STI were performed,and indicators of myocardial injury were measured.The correlation between the measurements of IVUS and 2D-STI and myocardial injury indicators was analyzed by the Pearson method.During the 12-month follow-up period,3 patients were lost to follow-up.According to whether MACE occurred,the patients were divided into the MACE group(n=43)and non-MACE group(n=179).The basic situation of STEMI patients was analyzed by univariate analysis;and logistic regression analysis was used to identify the influencing factors of MACE.The ROC curve was used to evaluate the diagnostic ability of IVUS and 2D-STI parameters in predicting MACE.Results The concentration of creatine kinase CK-MB in 225 patients with acute STEMI was(16.23±3.09)U/L,and the level of cardiac troponin cTnI was(0.36±0.05)ng/L.The parameters of 2D-STI and the minimum lumen diameter(MLD)and minimum lumen area(MLA)had a significant negative correlation with the concentrations of CK-MB and cTnI(P<0.05),while the measurement of area stenosis rate(AS)was positively correlated with the concentrations of these two biochemical indicators(P<0.05).Further analysis found that the AS value of the MACE group was significantly higher than that of the non-MACE group,with a statistically significant difference(P<0.05).The MLD,MLA,global circumferential strain(CS),global radial strain(RS),and longitudinal strain(LS)values of patients in the MACE group were significantly lower than those of patients in the non-MACE group.Logistic regression analysis found that MLA,AS,RS and LS were the main factors affecting the occurrence of MACE.The ROC curve further verifies the predictive value of these parameters.Among them,the critical value of MLA was 3.56 mm2,that of AS was 69.87%,that of RS was 29.87%,and that of LS was 23.05%.The sensitivities and specificities were 69.77%and 70.95%,81.40%and 71.51%,60.47%and 61.45%,86.05%and 79.33%respectively.The AUC value showed that the above parameters had good discriminating ability,especially the AUC value of LS was as high as 0.899(95%CI 0.799-0.999),while the sensitivity and specificity of the overall regression analysis reached 95.35%and 94.41%,and the AUC value was 0.993(95%CI 0.979-1.000).Conclusion Intravascular ultrasound and twodimensional strain imaging technology provide accurate imaging support for the assessment of myocardial damage in patients with acute STEMI.Their related quantitative indicators show significant abnormal expression when MACE occurs in patients with acute STEMI.They would become the important factors in predicting MACE risk.
作者
白敬淼
史苏娜
贾相科
BAI Jing-miao;SHI Su-na;JIA Xiang-ke(Cardiovascular Ultrasound Room,Xingtai Central Hospital,Xingtai 054000,China;Department of Cardiology,Xingtai Central Hospital,Xingtai 054000,China)
出处
《中国心血管病研究》
CAS
2024年第11期1040-1045,共6页
Chinese Journal of Cardiovascular Research
基金
邢台市重点研发计划项目(2021ZC104)。
关键词
血管内超声
二维斑点追踪
ST段抬高型心肌梗死
心肌损伤
主要不良心血管事件
预测价值
Intravascular ultrasound
Two-dimensional speckle tracking
ST-segment elevation myocardial infarction
Myocardial injury
Major adverse cardiovascular events
Predictive value
