右室应变对急性心肌梗死后恶性室性心律失常的预测价值分析

Predictive value of right ventricular strain in malignant ventricular arrhythmias after acute myocardial infarction

目的探讨右室应变功能在预测急性心肌梗死(AMI)后恶性室性心律失常中的应用价值。方法对439例AMI患者行超声心动图检查,测量其常规超声参数及右室游离壁整体纵向峰值应变(RV-GLS)。于AMI后每个月行24 h动态心电图检查,以监测出现室性心律失常为随访终点,共随访12个月。根据AMI后是否发生恶性室性心律失常或因心律失常而入院或死亡,将患者分为发生事件组121例和未发生事件组318例。采用多因素回归模型分析RV-GLS对AMI后发生室性心律失常的预测价值。结果发生事件组年龄和Killip分级均大于未发生事件组,而三尖瓣环收缩期位移、RV-GLS及左室射血分数均低于未发生事件组(均P<0.05)。多因素回归分析显示RV-GLS是AMI后恶性室性心律失常发生风险的独立预测指标(OR=1.13,95%CI:1.01～1.86,P=0.005)。结论 RV-GLS是AMI后发生恶性室性心律失常风险的独立预测指标,准确评估AMI患者右室功能有助于临床采取有效措施降低心脑血管疾病的发生率和病死率,具有较好的应用价值。

Objective To explore the application value of right ventricular strain function in predicting malignant ventricular arrhythmia after acute myocardial infarction(AMI). Methods A total of 439 patients with AMI were selected,and their routine ultrasound parameters were measured by echocardiography,and the global longitudinal peak strain(RV-GLS)of the right ventricular free wall was evaluated. 24 h dynamic electrocardiogram was performed every month after AMI. The end point of follow-up was monitoring ventricular arrhythmias. The patients were followed up for 12 months. According to the follow-up electrocardiogram after AMI,the patients were divided into event group(n=121)and non-event group(n=318)to monitor whether malignant ventricular arrhythmias occurred or whether they were hospitalized or died from arrhythmias. Multivariate regression model was used to analyze the correlation between RV-GLS and ventricular arrhythmia after AMI. Results The age and Killip grade of the event group were higher than those of the non-event group,while the systolic displacement of tricuspid annulus,RVGLS and left ventricular ejection fraction of the event group were lower than those of the non-event group(all P<0.05).Multivariate regression analysis showed that RV-GLS was an independent predictor of the risk of ventricular arrhythmia after AMI(OR=1.13, 95% CI:1.01~1.86,P=0.005). Conclusion RV-GLS is an independent predictor of the risk of ventricular arrhythmia in patients with AMI.It is helpful to identify malignant arrhythmia in early stage,and can effectively reduce the incidence and mortality of cardiovascular and cerebrovascular diseases .