应用脉冲波组织多普勒成像评估左心室血栓风险及其预后

Evaluation of risk and prognosis of left ventricular thrombus using pulsed wave tissue Doppler imaging

目的探究通过脉冲波组织多普勒成像(pulsed wave tissue Doppler imaging,PW-TDI)评估左心室血栓风险及预后的价值。方法收集2019年9月~2021年12月上海市复旦大学附属中山医院青浦分院心内科及呼吸科转诊的冠心病患者62例。在超声心动图检测到左心室血栓的患者中进行PW-TDI研究,根据是否发生主要不良心血管事件(major adverse cardiovascular events,MACE)分为两组。MACE组(12例),非MACE组(50例)。随访1年后,评估患者MACE的发生率,包括因中风或全身性栓塞导致的全因死亡率及住院率,研究与MACE发生相关的PW-TDI测量指标。结果所有患者的血栓均位于左心室心尖。在1年的随访中,12例患者发生MACE,未发生MACE患者50例。单变量Cox分析显示,与MACE相关的变量包括心率(P=0.03)、有游离边缘活动的血栓(P=0.02)、低回声血栓(P=0.03)、血栓峰值顺行速度(Va)≥10 cm/s(P=0.003)。多变量分析显示,游离边缘的血栓(P=0.02)和血栓峰值Va≥10 cm/s(P=0.01)与MACE显著相关。结论PW-TDI的测量指标可以客观预测因左心室血栓发生MACE的风险。

Objective To explore the risk and prognostic value of left ventricle thrombus activity by measuring parameters of pulsed wave tissue Doppler imaging(PW-TDI).Methods A total of 62 patients with coronary heart disease who were referred from the Department of Cardiology and Department of Respiratory Medicine in the Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University in Shanghai from September 2019 to December 2021 were collected.A PW-TDI study was performed in patients with left ventricular thrombus detected by echocardiography,they were divided into two groups according to the occurrence of major adverse cardiovascular events(MACE);the MACE group(n=12)and non-MACE group(n=50).After 1 year of follow-up,the incidence of MACE including all-cause mortality and hospitalization due to stroke or systemic embolism was evaluated,and the PW-TDI measurement indicators related incidence of MACE were investigated.Results All the 62 patients had thrombi located in the apex of the left ventricle.During 1-year follow-up,12 patients in MACE group and 50 patinents in non-MACE group.Univariate Cox analysis results showed that variables associated with MACE included heart rate(P=0.03),thrombus with free edge activity(P=0.02),hypoechoic thrombus(P=0.03),peak thrombus antegrade velocity(Va)≥10 cm/s(P=0.003).Multivariate analysis results showed that the thrombus at the free edge(P=0.02)and the thrombus peak Va≥10 cm/s(P=0.01)were significantly associated with MACE.Conclusion PW-TDI measurement indicators can objectively predict the risk of MACE due to left ventricular thrombus.