超声心动图与四维斑点追踪显像技术对急性心肌梗死患者PCI术后左心功能的评价及预后相关分析

Evaluation of left ventricular function in myocardial infarction patients undergoing PCI by echocardiography and four-dimensional speckle tracking imaging

目的 探讨超声心动图(UCG)与四维斑点追踪显像技术(4D-STI)评估急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后左心功能及预后的价值。方法 前瞻性选取2020年1月至2021年7月于黄河三门峡医院行PCI治疗的AMI患者102例为观察组,选择同期来院体检的健康者35例为对照组。于患者术前、术后7 d以及对照组体检当日行UCG与4D-STI检查,检测左房、左室相关心功能参数[左心室舒张末内径(LVEDD)、左心室收缩末内径(LVESD)、左心室收缩末期容积指数(LVESVI)、左心室舒张末期容积指数(LVEDVI)、左心室射血分数(LVEF)、左心房整体纵向应变(LS)、整体径向应变(RS)、整体圆周应变(CS)、整体面积应变(AS)]。记录患者术后10个月内出现心源性死亡概率,根据死亡情况分为存活组(80例)和死亡组(22例),采用独立样本t检验比较2组患者临床指标,Logistic回归分析影响心肌梗死患者PCI治疗后预后不良的因素。建立受试者操作特征(ROC)曲线,评估UCG与4D-STI预测预后的价值。结果 AMI患者PCI术后LVEDD、LVESD、LVESVI、LVEDVI、LS、CS、AS小于术前,LVEF、RS大于术前,差异有统计学意义(P<0.001)。对照组LVEDD、LVESD、LVESVI、LVEDVI、LS、CS、AS小于AMI患者PCI术前、术后,LVEF、RS大于PCI术前、术后,差异有统计学意义(P<0.05)。不同预后患者LVEDD、LVESD、LVESVI、LVEDVI、LVEF、LS、RS、CS、AS比较,差异有统计学意义(P<0.001)。Logistic回归分析显示LVEF、LS、RS是影响AMI患者预后的危险因素(P<0.05)。LVEF、LS、RS单独预测AMI患者预后不良的曲线下面积(AUC)分别为0.844、0.795、0.792,联合预测AUC为0.855。结论 AMI患者PCI术后左心功能可出现明显好转,UCG与4D-STI均可对AMI患者PCI术后左心功能恢复情况进行评价,且二者联合预测时敏感度、特异度稳定性更好。

Objective To explore the value of echocardiography and four-dimensional speckle tracking imaging(4D-STI) in evaluating left ventricular function and prognosis in the patients with myocardial infarction after percutaneous coronary intervention(PCI).Methods Totally 102 patients with myocardial infarction who underwent PCI in Yellow River Sanmenxia Hospital from January 2020 to July 2021 were prospectively selected as the observation group,while another 35 healthy people who came to the hospital for physical examination within the same time span were designated as the control group.UCG and 4D-STI were performed before surgery and 7 days after surgery.Left atrium and left ventricular functional parameters were detected:left ventricular end-diastolic diameter(LVEDD),left ventricular end-diastolic volume index(LVEDVI),left ventricular end-diastolic index(LVESDI),left ventricular ejection fraction(LVEF),left atrial global longitudinal strain(LS),global radial strain(RS),global peripheral strain(CS) and global area strain(AS).Medical follow-ups 10 months after surgery analyzed the rate of cardiac death within 10 months after surgery.Then,the patients were divided into the survival group(80 cases) and the death group(22 cases) according to the death of the patients.Logistic regression analysis was used to identify prognostic adverse factors affecting the patients with myocardial infarction after PCI.Receiver operating characteristic curve(ROC) was established to evaluate the prognostic value of UCG and 4DSTI.Results The levels of LVEDD,LVESD,LVESVI,LVEDVI,LS,CS and AS in the AMI patients after surgery were lower than those before PCI;LVEF and RS were higher than those before PCI(P<0.001).The levels of LVEDD,LVESD,LVESVI,LVEDVI,LS,CS and AS in the control group were lower than those of the AMI patients both before and after PCI;LVEF and RS were higher than those of the AMI patients both before and after PCI;and statistical significance coud be noted,when comparisons were made between them(P<0.05).There was statistical significance in the levels of LVEDD,LVESD,LVESVI,LVEDVI,LVEF,LS,RS,CS and AS in the patients with different prognoses(P<0.001).Logistic regression analysis showed that LVEF,LS and RS were risk factors affecting the prognosis of AMI patients(P<0.05).The areas under adverse prognosis curve(AUC) of the AMI patients were respectively 0.844,0.795 and 0.792,when LVEF,LS and RS were used to predict alone and the combined AUC prediction was 0.855.Conclusion The left ventricular function of the patients with AMI after PCI could be improved significantly.UCG and 4DSTI could be used to evaluate the recovery of left ventricular function of AMI patients after PCI.Furthermore,combined prediction with UCG and 4D-STI displays better sensitivity,specificity and good stability.