四维自动左室定量分析技术联合动态心电图预测急性心肌梗死患者预后的临床价值

Clinical value of four-dimensional automatic left ventricular quantitation technology combined with dynamic electrocardiogram in predicting the prognosis of patients with acute myocardial infarction

目的探讨四维自动左室定量分析(4D AUTO LVQ)技术联合动态心电图预测急性心肌梗死(AMI)患者预后的临床应用价值。方法选取我院收治的AMI患者83例,依据是否发生主要不良心血管事件(MACE)分为MACE组12例和非MACE组71例(非MACE组),两组均行常规超声心动图、4D AUTO LAQ和动态心电图检查,比较相关检测参数的差异。分析两组超声心动图参数、动态心电图心率变异性参数与MACE发生的相关性。绘制受试者工作特征(ROC)曲线分析4D AUTO LVQ技术联合动态心电图预测AMI患者预后的诊断效能。结果常规超声心动图检查结果显示,两组左房排空容积(LAEV)、左房被动射血分数(LAPEF)、左房主动射血分数(LAAEF)、左室射血分数(LVEF)、左房最大容积指数(LAVImax)比较差异均有统计学意义(均P<0.05);4D AUTO LVQ检查结果显示,两组整体峰值纵向应变(GLPS)、面积应变(GAPS)、环向应变(GCPS)、径向应变(GRPS)比较差异均有统计学意义(均P<0.05);动态心电图检查结果显示,两组全部窦性心搏RR间期的标准差(SDNN)、RR间期平均值的标准差(SDANN)、相邻RR间期差值的均方根(RMSSD)、低频成分与高频成分的比值(LF/HF)、相邻RR间期相差>50 ms的个数占总窦性心搏个数的百分比(PNN50)比较差异均有统计学意义(均P<0.001)。相关性分析显示,LAEV、LAPEF、LVEF、GAPS、SDNN与MACE发生均呈负相关,LAVImax与MACE发生呈正相关(均P<0.001)。ROC曲线分析显示,LAEV、LAPEF、LVEF、LAVImax、GAPS、SDNN联合应用预测AMI患者预后的曲线下面积为0.841,灵敏度、特异度分别为65.36%、79.22%。结论4D AUTO LVQ技术联合动态心电图对AMI患者预后有较高的预测价值,可为临床治疗提供参考依据。

Objective To investigate the clinical application value of four-dimensional automatic left ventricular quantitation(4D AUTO LVQ)technology combined with dynamic electrocardiogram in predicting the prognosis of patients with acute myocardial infarction(AMI).Methods A total of 83 patients with AMI admitted to our hospital were selected and divided into the major adverse cardiovascular events(MACE)group(n=12)and the non-MACE group(n=71)according to whether MACE occured.Both groups received conventional echocardiography,4D AUTO LVQ and dynamic electrocardiography,and the differences in relevant detection parameters were compared.The correlation between echocardiographic parameters,HRV parameters of dynamic electrocardiogram and the incidence of MACE were analyzed.The efficacy of 4D AUTO LVQ technology combined with dynamic electrocardiogram in predicting the prognosis of patients with AMI was evaluated by receiver operating characteristic(ROC)curve.Results Conventional echocardiography showed that the left atrial emptying volume(LAEV),left atrial passive ejection fraction(LAPEF),left atrial active ejection fraction(LAAEF),left ventricular ejection fraction(LVEF)and maximum left atrial volume index(LAVImax)between the two groups were statistically significant(all P<0.05).4D AUTO LVQ showed that the global longitudinal peak systolic strain(GLPS),global area peak strain(GAPS),global circumferential peak strain(GCPS)and global radial peak strain(GRPS)between the two groups were statistically significant(all P<0.05).Dynamic electrocardiogram showed that the standard deviation of normal RR intervals(SDNN),the standard deviation of the average of RR intervals(SDANN),the root mean square of successive RR interval differences(RMSSD),the ratio of lowfrequency components to high frequency components(LF/HF),the percentage of the number of 50 ms in the total number of sinus heart beats(PNN50)between the two groups were statistically significant(all P<0.001).Correlation analysis showed that LAEV,LAPEF,LVEF,GAPS and SDNN were negatively correlated with the occurence of MACE,while LAVImax was positively correlated with the occurence of MACE(all P<0.001).ROC curve analysis showed that the area under the curve of LAEV,LAPEF,LVEF,LAVImax,GAPS and SDNN in combined for predicting the prognosis of patients with AMI was 0.841,and the sensitivity and specificity were 65.36%and 79.22%,respectively.Conclusion 4D AUTO LVQ technology combined with dynamic electrocardiogram is of high prognostic value in patients with AMI and can provide a reference for clinical treatment.