左室射血分数及血钾离子水平与心肌梗死后室性心动过速患者术后复发的关系研究

Relationship between left ventricular ejection fraction and serum potassium level and postoperative recurrence of ventricular tachycardia after myocardial infarction

目的 研究左室射血分数(LVEF)及血钾离子水平与心肌梗死后室性心动过速(VT)患者术后复发的关系。方法 回顾性分析自2016年1月至2021年1月于徐州市中心医院心血管内科335例行导管消融术的心肌梗死后VT患者的临床资料。随访12个月,根据VT复发情况将患者分为复发组和未复发组。比较两组LVEF、血钾离子水平及临床资料;采用Logistic回归分析法分析心肌梗死后VT术后复发的危险因素;绘制受试者工作曲线(ROC),评价LVEF、血钾离子水平预测心肌梗死后VT术后复发的效能。结果 335例心肌梗死后VT患者术后复发30例(8.96%)设为复发组,其余305例设为未复发组。与未复发组比较,复发组LVEF、血钾离子水平均降低,吸烟、高血压、心室壁瘤、VT发作时血流动力学不稳定构成比均升高(P<0.05)。Logistic逐步回归分析显示,吸烟、高血压、心室壁瘤、VT发作时血流动力学、LVEF、血钾离子水平均是心肌梗死后VT术后复发的危险因素(P<0.05)。ROC结果显示,LVEF、血钾离子水平预测心肌梗死后VT术后复发的最佳截断点分别为47.55%、3.04 mmol/L,两者单独及联合检测预测VT复发的AUC分别为0.858(95%CI:0.816~0.894,P<0.05)、0.869(95%CI:0.828~0.903,P<0.05)、0.943(95%CI:0.861~0.984,P<0.05),两者联合检测的预测价值高于LVEF单独检测(P=0.032)及血钾离子水平单独检测(P=0.029)。结论 LVEF及血钾离子水平对心肌梗死后VT患者术后复发具有较高的预测效能,可为临床预防提供依据。

Objective This study aims to investigate the relationship between left ventricular ejection fraction(LVEF),serum potassium levels,and the postoperative recurrence of ventricular tachycardia(VT) in patients with myocardial infarction.Methods A retrospective analysis was conducted on the clinical data of 335 patients with VT after myocardial infarction who underwent catheter ablation at Xu Zhou Central Hospital's Cardiovascular Department between January 2016 and January 2021.After a 12-month follow-up period,the patients were divided into two groups based on VT recurrence:the recurrence group and the non-recurrence group.A comparison was made between the two groups in terms of LVEF,serum potassium levels,and clinical data.Logistic regression analysis was employed to identify the risk factors for postoperative VT recurrence after myocardial infarction.Receiver operating curves(ROCs) were generated to assess the predictive ability of LVEF and serum potassium levels regarding postoperative VT recurrence after myocardial infarction.Results Among the 335 patients with VT after myocardial infarction,30 experienced postoperative recurrence,accounting for 8.96% of the cases.These 30 patients comprised the recurrence group,while the remaining 305 patients constituted the non-recurrence group.Compared to the non-recurrence group,the recurrence group exhibited lower average LVEF and serum potassium levels,as well as increased proportions of smoking,hypertension,cardiac ventricular aneurysm,and hemodynamic instability during VT episodes(P<0.05).Logistic stepwise regression analysis revealed that smoking,hypertension,cardiac ventricular aneurysm,hemodynamic instability during VT episodes,LVEF,and serum potassium level were all identified as risk factors for postoperative VT recurrence after myocardial infarction(P<0.05).ROC analysis indicated that the optimal cut-off points for predicting postoperative VT recurrence after myocardial infarction were 47.55% for LVEF and 3.04 mmol/L for serum potassium levels.The individual and combined detection of these two factors yielded AUC values of 0.858(95%CI:0.816~0.894,P<0.05),0.869(95%CI:0.828~0.903,P<0.05),and 0.943(95%CI:0.861~0.984,P<0.05),respectively.The combined detection demonstrated superior predictive value compared to LVEF alone(P=0.032) and serum potassium level alone(P=0.029).Conclusion LVEF and serum potassium levels exhibit a high predictive efficacy for postoperative VT recurrence in patients with myocardial infarction,offering valuable insights for clinical prevention.