超声分层应变成像技术评估急性心肌梗死患者发生主要不良心血管事件的价值研究

Ultrasonic layered strain imaging in evaluation of major adverse cardiac events in patients with acute myocardial infarction

目的 探讨超声分层应变成像技术评估急性心肌梗死(AMI)患者心肌运动协调性和主要不良心血管事件(MACE)的应用价值。方法 回顾2020年6月至2022年1月金华市中心医院首次确诊AMI患者154例(研究组),采用二维斑点追踪成像(2D-STI)测量治疗前和治疗1个月后的左心室心肌整体纵向应变(GLS),超声分层应变成像技术测量左心室心内膜下心肌、中层心肌和心外膜下心肌的GLS(GLS内、GLS中和GLS外)以及峰值应变离散度(PSD)和跨壁差值△GLS(GLS_内-GLS_外),并与同期42例无器质性心脏疾病的志愿者(对照组)进行比较。研究组患者经介入治疗后常规随访1年,记录MACE发生情况。采用多因素Cox回归筛选预测MACE的危险因素,绘制ROC曲线分析危险因素预测MACE的效能。结果 与对照组相比,研究组GLS、GLS_内、GLS_中、GLS_外、△GLS和PSD均明显增加(均P<0.01),而左心室射血分数(LVEF)和左心室舒张末期内径(LVEDd)比较差异均无统计学意义(均P>0.05)。研究组治疗1个月后,GLS_内、△GLS和PSD较治疗前明显下降(均P<0.01),而GLS、GLS_中、GLS_外、LVEF和LVEDd均无明显改善(均P>0.01)。研究组随访1年有22例(14.3%)发生MACE,多因素Cox回归分析显示,GLS内(HR=1.859,95%CI:1.325~2.456,P<0.01)和PSD(HR=1.647,95%CI:1.242~2.013,P<0.01)是预测发生MACE的独立危险因素。ROC曲线分析显示,GLS内和PSD预测发生MACE的AUC分别为0.856(95%CI:0.802~0.899,P<0.01)和0.812(95%CI:0.746~0.878,P<0.01)。结论 超声分层应变成像技术测量GLS_内、△GLS和PSD能更加准确反映心肌运动的协调性障碍,对评估心室重构和MACE具有重要意义。

Objective To explore the value of ultrasonic layered strain imaging in evaluation of myocardial motion coordination and major adverse cardiac event(MACE)in patients with acute myocardial infarction(AMI).Methods A total of 154 patients with AMI who were firstly diagnosed in Jinhua Municipal Central Hospital from June 2020 to January 2022 were enrolled(study group),and 42 healthy subjects were selected as the control group.Two-dimensional speckle tracking imaging(2D-STI)were performed before and one month after treatment,and the global longitudinal strain(GLS)of left ventricular myocardium was measured in the study group.Ultrasonic layered strain imaging was used to measure the GLS of endocardial,middle and epicardial myocardium of the left ventricle(GLSendo,GLSmid,and GLSepi),peak strain dispersion(PSD),and transmural difference△GLS(GLSendo-GLSepi).Patients with AMI were routinely followed up for 1 year after interventional treatment,and MACE was recorded.Multivariate Cox regression was used to analyze the predictive factors of MACE,ROC curve was used to evaluate the value of the factors for predicting MACE.Results GLS,GLSendo,GLSmid,GLSepi,△GLS and PSD in the study group were significantly higher than those in control group(all P<0.01);while there were no significant differences in left ventricular ejection fraction(LVEF)and left ventricular end diastolic diameter(LVEDd)between two groups(P>0.05).After one month of treatment in the study group,the levels of GLSendo,△GLS and PSD were significantly decreased compared to those before treatment(all P<0.01).However,there were no improvements in GLS,GLSmid,GLSepi,LVEF,and LVEDd(P>0.05).MACE occurred in 22 cases(14.3%)in the study group during 1 year follow-up.Multivariate Cox regression showed that GLSendo(HR=1.859,95%CI:1.325-2.456,P<0.01)and PSD(HR=1.647,95%CI:1.242-2.013,P<0.01)were independent predictors of MACE.ROC showed that area under curve(AUC)of GLSendo and PSD for predicting MACE was 0.856(95%CI:0.802-0.899,P<0.01)and 0.812(95%CI:0.746-0.878,P<0.01),respectively.Conclusion The GLSendo and PSD measured by ultrasonic layered strain imaging can by used for evaluating ventricular remodeling and MACE in AMI patients.