超声心动图评价ST段抬高型心肌梗死并慢性阻塞性肺疾病右心室收缩功能的价值

Value of echocardiogram in evaluating right ventricular systolic function of STEMI patients with chronic obstructive pulmonary disease

目的探讨超声心动图评价ST段抬高型心肌梗死(STEMI)并慢性阻塞性肺疾病(COPD)患者右心室收缩功能的价值。方法选择2012年1月~2014年12月我院收治的STEMI患者236例,根据是否伴COPD,分为COPD组118例和不伴COPD组118例。回顾性分析2组患者临床资料及超声心动图检查指标。患者随访5年。右心室收缩功能障碍(RVSD)可由三尖瓣环收缩期位移(TAPSE)<17mm、右心室面积变化率(RVFAC)<35%、三尖瓣环收缩期峰值速度(S′)<6cm/s、右心室游离壁整体应变(RVLSfw)>-20%中任意一项定义。采用多因素logistic回归分析RVSD的影响因素,采用Kaplan-Meier曲线分析及Cox比例风险回归模型分析5年全因病死率。结果与不伴COPD组比较,COPD组肺动脉收缩压显著升高,RVFAC和RVLSfw等显著降低(P<0.05);以RVLSfw>-20%定义RVSD时,COPD组RVSD发生率显著高于不伴COPD组(45.8%vs 32.2%,χ2=4.560,P=0.033)。logistic回归分析显示,以TAPSE<17mm定义RVSD时,右心房容积为影响因素;以RVFAC<35%定义RVSD时,右冠状动脉、收缩压为影响因素;以RVLSfw>-20%定义RVSD时,COPD为影响因素(OR=1.84,95%CI:1.04~3.38,P=0.042)。Kaplan-Meier生存曲线示,RVLSfw>-20%和S′<6cm/s的COPD患者5年累积生存率显著降低(P<0.05)。Cox比例风险回归模型分析示,RVLSfw>-20%定义RVSD与5年全因病死率独立相关(HR=2.04,95%CI:1.13~3.74,P=0.018)。结论COPD患者STEMI后,RVLSfw变化更明显,COPD与RVSD显著相关,且RVLSfw>-20%者存活率降低。

Objective To study the value of echocardiogram in evaluating right ventricular systolic function(RVSD)of ST segment elevation myocardial infarction(STEMI)patients with chronic obstructive pulmonary disease(COPD).Methods Two hundred and thirty-six STEMI patients admitted to our hospital from January 2012to December 2014were divided into COPD group(n=118)and COPD-free group(n=118).Their clinical data and echocardiography parameters were retrospectively analyzed.The patients were followed up for 5years.The RVSD was defined as tricuspid annulus systolic displacement(TAPSE)<17mm,right ventricle area change rate(RVFAC)<35%,tricuspid annulus systolic peak velocity(S′)<6cm/s,and right ventricular free wall overall strain(RVLSfw)>-20%respectively.The influencing factors of RVSD were analyzed by multivariate logistic regression analysis.The 5-year all-cause death rate was analyzed by Kaplan-Meier curve analysis and Cox proportional harzards regression model analysis respectively.Results The pulmonary artery systolic pressure was significantly higher while the RVFAC and RVLSfw were significantly lower in COPD group than in COPD-free group(P<0.05).The rate of RVSD was significantly higher in COPD group than in COPD-free group when RVSD was defined as RVLSfw>-20%(45.8%vs 32.2%,χ2=4.560,P=0.033).Multivariate logistic regression analysis showed that the right atrium volume was an influencing factor of RVSD when RVSD was defined as TAPSE<17mm,the right coronary artery and systolic blood pressure were two influencing factors of RVSD when RVSD was defined as RVFAC<35%,the COPD was an influencing factor of RVSD when RVSD was defined as RVLSfw>-20%(OR=1.84,95%CI:1.04-3.38,P=0.042).Kaplan-Meier survival curve analysis showed that the 5-year cumulative survival rate was significantly lower in COPD group than in COPD-free group when RVSD was defined as RVLSfw>-20%and S'<6cm/s(P<0.05).Cox proportional harzards regression model analysis showed that the RVSD defined as RVLSfw>-20%was independently related with the 5-year all-cause death rate(HR=2.04,95%CI:1.13-3.74,P=0.018).Conclusion RVLSfw changes significantly in STEMI patients with COPD which is closely related with RVSD.The survival rate of STEMI patients with COPD is low when RVSD is defined as RVLSfw>-20%.