左室整体长轴应变对急性心肌梗死后冠状动脉微循环障碍的诊断价值

Diagnostic value of global longitudinal strain for coronary microcirculation dysfunction in patients with acute myocardial infarction

目的:评估左室整体长轴应变(GLS)对于急性心肌梗死(AMI)后冠状动脉(冠脉)微循环障碍(CMD)的诊断价值。方法:回顾性入选2015年11月-2021年7月北京大学人民医院因AMI住院并于住院期间完成心肌声学造影(MCE)的患者171例。应用斑点追踪显像(STI)技术测定GLS,应用MCE评估患者冠脉微循环状态。绘制受试者工作特征(ROC)曲线评估GLS对CMD的诊断价值,并寻找合适的诊断截断值。应用Logistic回归方程建立包括GLS在内的多参数CMD预测模型。结果:171例患者中有103例(60.2%)存在CMD。CMD组患者GLS为-10.8%(-8.4%~-12.8%),显著差于不伴CMD组-14.4%(-11.2%~-17.0%)(P<0.001)。GLS单独诊断CMD的ROC曲线下面积(AUC)为0.718(95%CI:0.635~0.801)。尤登指数最大时对应GLS截断值为-12.7%,其对CMD诊断的特异性为69.4%,敏感性为75.0%。进一步结合罪犯血管和肌钙蛋白I(TnI)峰值后,对CMD诊断的AUC提高至0.792(95%CI:0.719~0.865)。结论:GLS对AMI后CMD有良好的诊断价值,可为AMI后冠脉微循环状态的判断提供新的参考信息。

Objective:To evaluate the predictive value of global longitudinal strain(GLS)for coronary microcirculation dysfunction(CMD)in patients with acute myocardial infarction(AMI).Methods:A total of 171 AMI patients who underwent spackle tracking imaging(STI)and myocardial contrast echocardiography(MCE)during hospitalization from November 2015 to July 2021 were retrospectively included.GLS was measured by STI and coronary microcirculation was evaluated by MCE.A receiver operating characteristic(ROC)curve was drawn to evaluate the value of GLS in diagnosing CMD and to find the appropriate diagnostic cutoff value.Multivariate logistic regression was used to built a multi-factor predictive model.Results:CMD occurred in 103 patients(60.2%).The GLS in patients with CMD was-10.8%(-8.4%to-12.8%),which was significantly lower than that in patients without CMD[-14.4%(-11.2%to-17.0%),P<0.001].The area under ROC curve(AUC)of GLS for predicting CMD was 0.718(95%CI 0.635 to 0.801).Youden index reached its maxmum when the cut-off of GLS was-12.7%with the sensitivity and specificity were 75.0%and 69.4%,respectively.When GLS combined with culprit vessel and peak troponin I(TnI),the AUC raised to 0.792(95%CI0.719 to 0.865).Conclusion:GLS has good predictive value for CMD in patients with AMI and provides new information for the evaluation of coronary microcirculation status after AMI.