实时三维斑点追踪超声心动图联合微小RNA评估早期急性心肌梗死危险程度的价值

Value of real-time three-dimensional speckle tracking echocardiography combined with micro RNA in assessing early acute myocardial infarction risk

目的探讨实时三维斑点追踪超声心动图(real-time three dimensional speckle tracking echocardiography,RT3D-STE)与外泌体微小核糖核酸(micro ribonucleic acid,miRNA)检测在评估早期急性心肌梗死(acute myo⁃cardial infarction,AMI)患者的危险程度中的价值。方法纳入2019年3月至2021年7月深圳市龙华区人民医院40例行冠状动脉造影(coronary arteriongraphy,CAG)的AMI患者,将SYNTAX评分≥23分且“罪犯血管”为近端闭塞者分为高危组,将SYNTAX评分<23分且“罪犯血管”为中远端闭塞者分为低危组,每组20例。患者于CAG后24 h内进行RT3D-STE,分别获取其三维左心室参数:左心室舒张末期容积(left ventricular end diastolic volume,LVEDV)、左心室收缩末期容积(left ventricular end systolic volume,LVESV)、左心室射血分数(left ventricular ejection fraction,LVEF)、心排血量(cardiac output,CO)、球形指数(spherical index,SpI)及左心室质量(left ventricular mass,LVMass),并获取三维左心室整体长轴应变(three-dimensional global long axis strain,3D-GLS)、环周应变(three-dimensional global circumferential strain,3D-GCS)、径向应变(three-dimensional global radial strain,3D-GRS)及面积应变(three-dimensional global area strain,3D-GAS),将其结果与20名健康者进行比较。对20例AMI患者的外周血血清进行外泌体miRNA检测,对显著差异表达的miRNA进行二次测序并定量,分别与CAG分组结果、三维左心室应变参数进行相关分析。结果高危组患者的RT3D-STE参数SpI、CO及LVEF分别为0.32±0.04、(3.19±0.85)L/min和47.77%±2.83%,与低危组、正常组比较,差异有统计学意义(P<0.05)。高危组患者的RT3D-STE左心室参数比低危组及正常组明显降低,差异有统计学意义(P<0.05)。3D-GLS和3D-GAS诊断高危组的敏感度最高。以3D-GLS=-9.31%为临界值,3D-GLS诊断高危组的敏感度为80%,特异度为90%;精细分析显示3D-GLS、3D-GAS、3D-GCS及3D-GRS均能够区分高危组与低危组。miRNA-3681-5p及miRNA-152-5p与3D-GLS、3D-GAS及3D-GCS呈负相关,与3D-GRS呈正相关。使用实时定量聚合酶链反应(quantitative real time polymerase chain reaction,qRT-PCR)对miR-3681-5p及miR-152-5p进行验证,单个miRNA-3681-5p及miRNA-152-5p即可完全区分高危组与低危组(P<0.01)。结论本研究应用RT3D-STE和miRNA评估AMI的结果,可能对AMI早期危险分层有一定指导作用。高危患者异常的超声参数(SpI、CO、LVEF、3D-GLS和3D-GAS)有可能作为AMI患者经皮冠状动脉介入治疗后随访主要不良心血管事件或者生存率相关的评估指标。

Objectives To explore the value of real-time three dimensional speckle tracking echocardiography(RT3D-STE)and exosome micro ribonucleic acid(miRNA)in assessing the risk of early acute myocardial infarction(AMI).Methods AMI patients(n=40)who underwent coronary angiography(CAG)were divided into high-risk group with Syntax score≥23 and proximal occlusion of culprit vessel(n=20),and low-risk group with Syntax score<23 and distal occlusion of culprit vessel(n=20)from March 2019 to July 2021 in People′s Hospital of Longhua District.RT3D-STE was performed in the patients within 24 h after CAG to obtain the left ventricular end diastolic volume(LVEDV),left ventricular end systolic volume(LVESV),left ventricular ejection fraction(LVEF),cardiac output(CO),spherical index(SpI)and left ventricular mass(LVMass).Three-dimensional global long axis strain(3D-GLS),three-dimensional global circumferential strain(3D-GCS),three-dimensional global radial strain(3D-GRS)and three-dimensional global area strain(3D-GAS)were obtained and compared with 20 healthy subjects.The exosome miRNA in 20 AMI patients was detected.The miRNAs with significant difference were sequenced and quantified,and the correlations between miRNA with CAG grouping and three-dimensional left ventricular strain were analyzed.Results The parameters of SpI,CO and LVEF in high-risk group were 0.32±0.04,(3.19±0.85)L/min and 47.77%±2.83%respectively,which were significantly different from those in low-risk group and normal group(P<0.05).RT3D left ventricular strain parameters were the main parameters to distinguish high-risk group,low-risk group and normal group.Compared with lowrisk group and normal group,RT3D left ventricular strain parameters in high-risk group were significantly lower(P<0.01).The sensitivities of 3D-GLS and 3D-GAS to detect high-risk group were the highest.With 3D-GLS=-9.31%as the critical value,the sensitivity and specificity of 3D-GLS in high-risk group were 80%and 90%,respectively.Precision analysis showed that 3D-GLS,3D-GAS,3D-GCS and 3D-GRS could distinguish high-risk group from low-risk group.The miR-3681-5p and miR-152-5p negatively correlated with 3D-GLS,3D-GAS and 3D-GCS,and positively correlated with 3D-GRS.Using quantitative real time polymerase chain reaction(qRT-PCR)to verify miRNA-3681-5p and miRNA-152-5p,single miRNA-3681-5p and miRNA-152-5p could completely distinguish high-risk group from low risk group(P<0.01).Conclusions The results of RT3D-STE and miRNA in evaluating AMI may be useful for early risk stratification of AMI.The abnormal ultrasound parameters(SPI,CO,LVEF,3D-GLS and 3D-GAS)of high-risk patients may be used to evaluate major adverse cardiovascular event or survival in AMI patients after percutaneous coronary intervention.