心电心音图对急性心肌梗死后早期心室重构的预测价值

Predictive value of acoustic cardiogram for early-stage ventricular remodeling after acute myocardial infarction:an analysis of 102 cases

目的探讨心电心音图参数对急性心肌梗死后早期心室重构的预测价值。方法纳入重庆医科大学附属第三医院心血管内科2021年6月至2022年2月入院后接受经皮冠状动脉介入治疗(percutaneous coronary intervention surgery,PCI)的急性心肌梗死(acute myocardial infarction,AMI)患者102例。对患者进行心电图、心脏超声、心肌损伤标志物、BNP和心电心音图检查。根据心脏超声左室射血分数(left ventricular ejection fraction,LVEF)测定结果,将患者分为早期心室重构(early ventricular remodeling,EVR)组(LVEF<50%,50例)和对照组(LVEF≥50%,52例),比较两组患者的基线数据和心电心音图参数。采用多因素logistic回归分析EVR的独立预测因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under the curve,AUC)评估独立预测因素对EVR的预测价值。结果EVR组的心电心音图参数电机械激动时间比值(electromechanical activation time divided by the cardiac cycle length,EMATc)、左室收缩时间比值(left ventricular systolic time divided by the cardiac cycle length,LVSTc)、第四心音强度(fourth heart sound,S4)、左室收缩功能障碍指数(systolic dysfunction index,SDI)均显著高于对照组(P<0.05)。logistic回归分析结果提示,在基线数据和心电心音图参数中,男性(OR=53.20,95%CI:3.80~1349.00,P=0.007)、心电心音图参数EMATc(OR=2.62,95%CI:1.77~4.30,P<0.001)和心脏超声左室舒张末期内径(left ventricular end diastolic dimension,LVEDD;OR=1.19,95%CI:1.03~1.42,P=0.029)进入最终的logistic回归模型中。EMATc水平可较好区分EVR患者(AUC=0.892,95%CI:0.834~0.949,P<0.001),当临界点设置为11.50时,敏感度可达76.0%。心脏超声参数LVEDD的最佳临界值为49.50 mm,特异度为86.5%,具有较高的排除诊断价值。结论心电心音图参数EMATc可用于预测急性心肌梗死后早期心室重构。

Objective To investigate the predictive value of acoustic cardiographic parameters for post-acute myocardial infarction(AMI)early ventricular remodeling(EVR).Methods A total of 102 AMI patients undergoing percutaneous coronary intervention(PCI)in our hospital during June 2021 and February 2022 were recruited in this study.Electrocardiography,cardiac Doppler ultrasound examination,and acoustic cardiography were performed for all of them.Their biomarkers of cardiac injury and brain natriuretic peptide(BNP)were detected and recorded.According to the value of left ventricular ejection fraction(LVEF),they were and divided into EVR group(<50%,n=50)and control group(≥50%,n=52).The baseline data and acoustic cardiographic parameters were compared between the 2 groups.Multivariate logistic regression analysis was applied to analyze the independent predictors for EVR,and the area under the curve(AUC)of receiver operating characteristic(ROC)were conducted to evaluate the predictive performances of these predictive factors.Results Among the acoustic cardiographic parameters,significantly higher electromechanical activation time divided by the cardiac cycle length(EMATc),left ventricular systolic time divided by the cardiac cycle length(LVSTc),fourth heart sound(S4)strength,and systolic dysfunction index(SDI)were observed in the EVR group than the control group(P<0.05).And in the clinical data and acoustic cardiographic parameters,male(OR=53.20,95%CI:3.80~1349.00,P=0.007),EMATc(OR=2.62,95%CI:1.77~4.30,P<0.001)and LVEDD(OR=1.19,95%CI:1.03~1.42,P=0.029)finally entered in the logistic regression model in a logistic regression model predicting EVR.EMATc level could satisfactorily distinguish those patients with EVR(AUC=0.892,95%CI:0.834~0.949,P<0.001),and when the cut-off point was set as 11.50,the sensitivity could be up to 76.0%.LVEDD level at an optimal cut-off value of 49.50 mm yielded a specificity of 86.5%,providing evidence for an exclusion diagnosis.Conclusion Acoustic cardiographic parameter EMATc is an independent predictor for EVR in AMI patients.