急性心肌梗死恢复期心功能变化趋势及预测指标探析

Predictors of cardiac function change from onset to recovery for patients with acute myocardial infarction

目的分析急性心肌梗死(AMI)后6个月左心室射血分数(LVEF)变化趋势并探究影响LVEF变化的潜在因素。方法回顾2018年5月至2021年5月于首都医科大学附属北京友谊医院冠心病监护病房接受诊治的226例AMI患者的临床资料,分为LVEF改善组(n=148)和LVEF未改善组(n=78)。所有患者均在入院后12 h内接受了经皮冠状动脉介入治疗。分析两组患者的基线资料特征、肝肾功能、血脂水平、N末端-B型利钠肽原、肌钙蛋白I(TnI)峰值、中性粒细胞淋巴细胞比值(NLR)、冠状动脉造影、超声心动数据、用药情况等,研究各项指标与LVEF变化趋势的关系。结果LVEF改善组反映炎症程度的指标NLR低,估测心肌梗死面积的指标TnI峰值低,基线LVEF较低。多重线性回归显示,基线LVEF低、NLR低、TnI峰值低能预测AMI恢复期的心功能改善。ROC曲线显示,NLR的最佳临界值6.29,基线LVEF的最佳临界值为59.50%,TnI峰值的最佳临界值为26.70 ng/ml。结论AMI急性期较低的心脏功能、较低的炎症状态和较小的估计梗死面积是将来心脏功能改善的预测指标。

Objective To analyze the changing of left ventricular ejection fraction(LVEF)at 6 months after acute myocardial infarction(AMI)and to explore its predictors.Methods A tatal of 226 AMI patients who received percutaneous coronary intervention within 12 hours from AMI onset in Beijing Friendship Hospital from May 2018 to May 2021 were enrolled and followed up for at least 6 months.They were divided into the group of LVEF improved(n=148)and the group of LVEF unimproved(n=78).Baseline data characteristics,laboratory testing including peak value of troponin I(TnI)and neutrophil lymphocyte ratio(NLR),coronary angiography images,echocardiography data and medications were collected and analyzed.Results The comparison between the two groups and multiple linear regression analysis showed that all the NLR,the peak value of TnI and the baseline LVEF were lower in the LVEF-improved group.Receiver operating characteristic curve showed that the cut-off values predicting improvement for NLR 6.29,for baseline LVEF 59.50%and for peak value of TnI 26.70 ng/ml.Conclusions Lower heart function,lower inflammatory status and smaller estimated infarction size during AMI are the indicators for the improvement of heart function after AMI.