二尖瓣口血流动力学指标和HEART评分对非ST段抬高型心肌梗死患者主要不良心血管事件发生风险的预测价值

Predictive value of mitral valve orifice hemodynamic indexes and HEART score in risk of major adverse cardiovascular events in patients with non-ST-segment elevation myocardial infarction

目的探讨二尖瓣口血流动力学指标和HEART评分对非ST段抬高型心肌梗死(NSTEMI)患者主要不良心血管事件(MACE)发生风险的预测价值。方法选取2018年2月至2020年2月就诊于陕西中医药大学第二附属医院急诊科的NSTEMI患者572例为研究对象。对所有患者随访30 d,根据30 d内MACE发生情况,将患者分为有MACE组和无MACE组。收集患者的一般临床资料,记录每例患者HEART评分,使用多普勒超声心动图检测左心房面积(LAA)、左心房容积(LAV)、二尖瓣平均跨瓣压差(MPGmv)、二尖瓣速度时间积分(VTImv)、二尖瓣压力降半时间(PHTmv)、二尖瓣有效瓣口面积(EOAmv)、二尖瓣E峰血流速度。通过建立Cox比例风险回归模型对NSTEMI患者发生MACE的影响因素进行多变量分析。采用受试者工作特征(ROC)曲线分析各指标对MACE发生风险的预测价值。结果572例NSTEMI患者随访30 d内发生MACE 97例(17.0%)。Cox比例风险回归模型结果显示,HEART评分、LAA、LAV、MPGmv、VTImv、PHTmv是NSTEMI患者发生MACE的独立危险因素,EOAmv是NSTEMI患者发生MACE的保护因素(均P<0.05)。ROC曲线分析结果显示,二尖瓣口血流动力学相关指标联合HEART评分预测NSTEMI患者发生MACE的曲线下面积大于各指标单独预测。结论二尖瓣口血流动力学指标联合HEART评分对NSTEMI患者MACE发生风险的预测价值大于各研究指标单独预测。

Objective To discuss the predictive value of mitral valve orifice hemodynamic indexes and HEART score in major adverse cardiovascular events(MACE)in patients with non-ST-segment elevation myocardial infarction(NSTEMI).Methods Totally 572 patients with NSTEMI admitted to Department of Emergency,the Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from February 2018 to February 2020 were selected.All patients were followed-up for 30 d.According to the occurrence of MACE within 30 d,patients were divided into MACE group and non-MACE group.The general clinical data of the patients were collected,and the HEART score was recorded.Left atrial area(LAA),left atrial volume(LAV),mean mitral valve pressure gradient(MPGmv),velocity time integral of mitral valve(VTImv),half time of mitral valve pressure drop(PHTmv),effective mitral valve orifice area(EOAmv)and E-peak flow velocity of mitral valve were measured by Doppler echocardiography.Through the establishment of Cox proportional hazard regression model,the factors affecting the occurrence of MACE in patients with NSTEMI were analyzed by multivariate analysis.The receiver operating characteristics(ROC)curve was used to analyze the predictive value of above index in MACE.Results Among 572 cases of NSTEMI,97 cases(17.0%)had MACE within 30 d followed-up.Cox proportional hazard regression model showed that HEART score,LAA,LAV,MPGmv,VTImv and PHTmv were independent risk factors of MACE,and EOAmv was a protective factor for MACE in NSTEMI patients(all P<0.05).The ROC curve analysis showed that the area under the curve of mitral valve orifice hemodynamic indexes combined with HEART score in predicting MACE in patients with NSTEMI is greater than those in the diagnosis alone.Conclusion Mitral valve orifice hemodynamic indexes combined with HEART score in predicting MACE is more valuable than those alone in patients with NSTEMI.