小剂量腺苷负荷超声检测对急性心肌梗死经皮冠状动脉介入治疗预后的预测价值

Prognostic Value of Low-Dose Adenosine Stress Echocardiography in Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention Treatment

目的:探讨小剂量腺苷负荷超声(LDASE)对急性心肌梗死(AMI)行经皮冠状动脉(冠脉)介入治疗(PCI)的患者临床预后的预测价值。方法:将行PCI且术后一周内行LDASE检测的AMI患者79例,记录运动异常节段数LDASE检测前后心室壁运动,并根据LDASE检测前后左心室收缩功能改善情况,将注射腺苷后患者左心室射血分数(LVEF)增加≥5%为改善组,LVEF增加<5%为未改善组。出院后随访24个月,比较两组临床特点及主要不良心脏事件(MACE)即心源性死亡、新发或恶化的心力衰竭、再发非致死性心肌梗死的差异;采用logistic回归分析确定影响临床预后的危险因素。结果:2组AMI患者性别组成、平均年龄、血管开通后左心室舒张末期内径、LVEF、血浆B型脑钠肽水平及入院Killip分级差异无统计学意义(P>0.05)。两组患者随访24个月未改善组MACE发生率较改善组升高(43.24%vs14.29%);与改善组相比,未改善组患者新发或恶化的心力衰竭的发生率(14.29%vs 37.84%)、再发非致死性心肌梗死的发生率(0.00%vs 5.41%)均升高,差异均具有统计学意义(P<0.05)。通过对相关因素的logistic回归分析发现,小剂量腺苷负荷状态下LVEF增加<5%、改善节段数≤3是预测临床预后的独立危险因素(P<0.05)。结论:AMI患者冠脉介入治疗后早期行LDASE检测是评估再灌注治疗后左心室功能的有效方法,可用于急性心肌梗死介入治疗后心血管不良事件的早期预测。

Objective： To explore the prognostic value of low-dose adenosine stress echocardiography （LDASE） in patients with acute myocardial infarction （AMI） after percutaneous coronary intervention （PCI）. Methods： We retrospectively summarized 79 AMI patients with PCI, and then received LDASE within 1 week of PCI to test their cardiac function. According to left ventricular eject fraction （LVEF） increased ≥ 5%, the patients were divided into 2 groups, Improved group, n=42 and Non-improved group, n=37. The patients were followed-up for 24 months. The main adverse cardiac events （MACE） were compared between two groups, and the logistic regression analysis was applied to identify the risk factor for clinical prognosis. Results： The gender, mean age, left ventricular diastolic diameter after PCI, LVEF, plasma BNP level and Killip classification at admission were similar between two groups,P〉0.05. The incidences of MACE for Improved group was significantly lower than that of Non-improved group （14.29% vs. 43.24%）, P〈0.05. Compared with Improved group, Non-improved group had more incidence of heart failure （14.29 % vs. 37.84%） and AMI （0.00% vs. 5.41%）, P〈0.05 respectively. Logistic regression analysis identified that LVEF increasing〈5% and segment improvement ≤ 3 were the risk factors for clinical prognosis. Conclusion： LDASE is an effective assessment for left ventricular function, it could be used for early prognosis of MACE in AMI patients after PCI.