急性ST段抬高型心肌梗死伴射血分数减少型心力衰竭患者左心室逆重构的预测因素

Predictors of left ventricular reverse remodeling in patients with reduced ejection fraction heart failure af⁃ter ST⁃segment elevation myocardial infarction

目的本研究分析急性ST段抬高型心肌梗死(STEMI)伴射血分数减少型心力衰竭(HFrEF)患者出现左心室逆重构(LVRR)的影响因素。方法收集2018年1月至2020年12月于郑大一附院心内科诊断STEMI行直接经皮冠状动脉介入治疗(PCI)的患者,将术后首次超声心动图测得LVEF小于40%的患者纳入,共108例。根据6个月后心脏彩超结果,将患者分为LVRR组和NLVRR组。比较两组基线及手术资料,采用多因素logistic分析LVRR的影响因素,ROC曲线分析其预测价值。结果LVRR组的NT⁃proBNP峰值、cTnT峰值、IBil、LVEDV、LVESV、总缺血时间(TIT)低于NLVRR组,左室短轴缩短率(FS)、完全血运重建高于NLVRR组(P<0.05)。回归分析发现,LVRR的独立影响因素为cTnT峰值、TIT、完全血运重建(P<0.05),cTnT峰值、TIT为危险因素,完全血运重建为保护因素。ROC曲线分析:cTnT峰值联合TIT的AUC高于cTnT峰值、TIT单一检测(AUC分别为0.817、0.714、0.737,P<0.05)。结论cTnT峰值、TIT、完全血运重建为STEMI伴HFrEF患者出现LVRR的独立影响因素,其中cTnT峰值、TIT为危险因素,完全血运重建为保护因素。cTnT峰值联合TIT对LVRR的预测价值高于二者单独的预测价值。

Objective To explore the influential factors of left ventricular reverse remod⁃eling(LVRR)in patients with reduced ejection fraction heart failure after ST⁃segment eleva⁃tion myocardial infarction.Methods A total of 108 patients who were confirmed with STEMI and had LVEF less than 40%after primary percutaneous coronary intervention(PCI)were enrolled.According to the results of echocardiogram indicators after six months,all patients were divided into LVRR group and NLVRR group.The routine baseline and operation data collected through the electronic medical record system were compared between the two groups.The multivariate Logistic regression model was used to explore the influential factors of LVRR.The receiver operating curve(ROC curve)was used to analyze the predictive values of related factors.Results Compared with NLVRR group,the prevalence of peak NT⁃proBNP,peak cTnT,IBil,LVEDV,LVESV,TIT were lower,while FS,complete revascularization were higher in LVRR group(P<0.05).Regression analysis found the influential factors of LVRR were peak cTnT,TIT and complete revascularization(P<0.05).Peak cTnT and TIT were risk factors for LVRR,while complete revascularization was protective factor.ROC curve analysis showed the AUC of TIT combined with peak cTnT detec⁃tion was higher than peak cTnT or TIT alone(AUC were 0.817,0.714 and 0.737,P<0.05).Conclusion Peak cTnT,TIT and complete revascularization were independent influential factors of LVRR in patient with HFrEF after STEMI.Peak cTnT and TIT were risk factors for LVRR,while complete revascularization was protective factor.The predictive value of peak cTnT combined with TIT for LVRR was higher than that of peak cTnT or TIT alone.