E/Ea在非ST段抬高型急性冠脉综合征危险分层中的价值

The value of E/Ea in the risk stratification of patients with non-ST-elevation acute coronary syndrome

目的探讨二尖瓣口舒张早期的血流峰值速度(E)与二尖瓣环舒张早期峰值速度(Ea)的比值(E/Ea)在非ST段抬高型急性冠脉综合征(NSTE-ACS)危险分层中的价值。方法对120例确诊NSTE-ACS的住院患者在入院时行危险分层,测定NT-proBNP并在入院24 h内行心脏彩超检查。同期门诊入选20例年龄相匹配的健康对照组行心脏彩超检查。以Simpsion法计算左室射血分数(LVEF),取标准心尖四腔心切面,测量E和二尖瓣环间隔侧Ea,计算E/Ea比值。结果 NSTE-ACS患者低危组的E/Ea与对照组相比无统计学差异(P>0.05),而中危组与低危组相比,高危组与中危组相比,E/Ea均显著增高(P<0.001)。相关分析显示,NST-ACS患者的E/Ea与NT-proBNP及危险分层均呈正相关(相关系数分别是r=0.56和r=0.52,P<0.001)。E/Ea和NT-proBNP诊断高危组NSTE-ACS患者的ROC曲线下面积分别是0.77(95%CI为0.67～0.86,P<0.001)和0.94(95%CI为0.89～0.98,P<0.001)。结论 E/Ea能够反映NSTE-ACS的严重程度,可以作为NSTE-ACS的危险分层的新指标。

Objective To investigate the value of mitral annular early diastolic velocity ratio（E/Ea）in risk stratification of patients with non-ST-elevation acute coronary syndrome（NSTE-ACS）.Methods 120 patients with NSTE-ACS were risk stratified when admitted to the hospital.NT-proBNP and Doppler echo tests were performed within 24 hours of admission.Twenty age-matched healthy subjects were enrolled as a control group in the clinic during the same time period and also received echo tests.Left ventricular ejection fraction（LVEF）was calculated by using Simpson＇s-method.In the apical four-chamber view,the E/Ea ratio was calculated by measure peak early mitral inflow velocities（E）and mitral annular early diastolic peak velocity（Ea）in the septal site.Results For NSTE-ACS patients,the E/Ea of the low-risk group showed no significant difference from that of the control group（P〈0.05）.However,the E/Ea of moderate-risk group was significantly higher than that of the low-risk group,as was the same with the E/Ea of high-risk group compared with moderate-risk group（P〈0.001）.Furthermore,the E/Ea ratio of NSTE-ACS patients correlated with NT-proBNP levels and risk stratification（r=0.56 and r=0.52 respectively,P〈0.001）.ROC Curve Analyses of E/Ea and NT-proBNP for Risk Stratification in Patients with NSTE-ACS showed that the areas under the ROC curve for the moderate and high risk group was 0.77（95% CI：0.67 to 0.86,P〈0.001）and 0.94（95% CI：0.89 to 0.98,P〈0.001）respectively.Conclusion E/Ea correlates with the severity of NSTE-ACS and might be as a new index for risk stratification of NSTE-ACS patients.