组织运动二尖瓣环位移对新型冠状病毒肺炎患者预后的预测价值

Prognostic value of tissue motion mitral annular displacement for patients with coronavirus disease 2019

目的探讨组织运动二尖瓣环位移(tissue motion mitral annular displacement,TMAD)自动追踪技术预测新型冠状病毒肺炎患者预后的价值。方法回顾性纳入2020年1月29日至2020年3月4日华中科技大学同济医学院附属协和医院收治的新型冠状病毒肺炎患者104例,根据预后情况将其分为死亡组18例与存活组86例。所有患者均接受床边超声心动图检查,获取左心室射血分数(LVEF)、左心室整体纵向应变(LVGLS)、二尖瓣环连线中点最大位移(MAD)及二尖瓣环连线中点最大位移率(%MAD),比较两组各参数的差异。绘制ROC曲线,得到MAD、%MAD预测不良预后的截断值,进一步行Logistic回归分析,得出新型冠状病毒肺炎患者死亡的危险因素并评价MAD及%MAD预测死亡风险的能力。结果与存活组相比,死亡组LVGLS绝对值、MAD及%MAD更低,差异具有统计学意义(P均<0.05)。LVGLS、MAD及%MAD预测死亡的ROC曲线下面积分别为0.777、0.622、0.669(P均<0.05)。根据ROC曲线分析,LVGLS、MAD、%MAD的截断值分别为-17.9%、12.0 mm、14.6%时,其敏感度分别为93.8%、75.0%、75.0%,特异度分别为62.3%、50.7%、55.8%。单因素Logistic回归显示,MAD≤12.0 mm、%MAD≤14.6%是新型冠状病毒肺炎患者死亡风险的预测因素,OR值分别为3.500、4.421(P均<0.05)。结论MAD、%MAD与新型冠状病毒肺炎患者预后密切相关,MAD、%MAD减低是新型冠状病毒肺炎患者死亡风险的预测因子,且操作简单快捷,不依赖于图像质量,具有良好的临床应用价值。

Objective To evaluate the value of tissue motion tracking of mitral annular displacement(TMAD)in predicting the prognosis of patients with coronavirus disease 2019(COVID-19).Methods A total of 104 COVID-19 patients admitted to Union Hospital of Tongji Medical College,Huazhong University of Science and Technology from January 29,2020 to March 4,2020 were retrospectively included.According to the outcome,they were divided into either a death group(18 patients)or a survival group(86 patients).All patients underwent bedside echocardiography.Left ventricular ejection fraction(LVEF),left ventricular global longitudinal strain(LVGLS),mitral annular displacement(MAD),and mitral annular displacement rate(%MAD)were measured,and the differences in parameters between the two groups were compared.The cutoff values of MAD and%MAD for predicting adverse outcome were obtained based on the ROC curve,and the ability of MAD and%MAD to predict death was evaluated with a logistic regression model.Results Compared with the survival group,the absolute values of LVGLS,MAD,and%MAD were significantly lower in the death group.The areas under the ROC curves of LVGLS,MAD,and%MAD were 0.777,0.622,and 0.669,respectively(P<0.05).The cutoff values of LVGLS,MAD,and%MAD were-17.9%,12.0mm,and 14.6%,respectively,with a sensitivity of 93.8%,75.0%,and 75.0%,and specificity of 62.3%,50.7%,and 55.8%,respectively.Univariate logistic regression showed that MAD(odds ratio[OR]=3.500,P<0.05)and%MAD(OR=4.421,P<0.05)can predict the risk of death in patients with COVID-19.Conclusion MAD and%MAD are significantly related to the prognosis of COVID-19 patients,and the reductions of MAD and%MAD are risk factors for high mortality risk in COVID-19 patients.The measurement of TMAD is simple and convenient,which makes it be of great value in clinical application.