三维斑点追踪技术评价心肌梗死患者心肌微循环特征及对左心室重塑的预测价值

Evaluation of myocardial microcirculation characteristics and predictive value of left ventricular remodeling in patients with myocardial infarction using three-dimensional speckle tracking imaging

目的:探讨三维斑点追踪技术评价心肌梗死患者心肌微循环特征及对左心室重塑的预测价值。方法:将2020年8月—2023年8月于郑州大学附属胸科医院收治的165例心肌梗死患者作为研究对象,根据左心室舒张末期容积指数增加率(Δleft ventricular end-diastolic volume index,ΔLVEDVI)将患者分为左心室重塑组(ΔLVEDVI>20%,74例)和无左心室重塑组(ΔLVEDVI≤20%,91例)。通过受试者工作特征(receiver operating characteristic,ROC)曲线评价心肌梗死患者心肌微循环特征对左心室重塑的预测价值。通过逐步回归法筛选心肌梗死患者左心室重塑的影响因素。建立心肌梗死患者左心室重塑的风险预测模型并进行验证。结果:冠脉介入时间、心梗面积、C反应蛋白(C-reactive protein,CRP)、金属蛋白酶9(matrix metalloproteinase-9,MMP-9)、血管内皮生长因子A(vascular endothelial growth factor-A,VEGF-A)、冠状动脉微循环阻力指数(index of microcirculatory resistance,IMR)、血流储备分数(fractional flow reserve,FFR)和冠状动脉血流储备(coronary flow reserve,CFR)均为影响心肌梗死患者左心室重塑的独立危险因素(P<0.05)。校准曲线结果均显示多因素Logistic回归模型具有较好的准确性。结论:心肌梗死患者心肌微循环特征对左心室重塑具有一定预测价值。

Objective:To explore the evaluation of myocardial microcirculation characteristics and predictive value for left ventricular remodeling in patients with myocardial infarction using three-dimensional speckle tracking imaging.Methods:A total of 165 patients with myocardial infarction admitted to Chest Hospital affiliated to Zhengzhou University from August 2020 to August 2023 were selected for the study.According to the increase rate of left ventricular end-diastolic volume index(ΔLVEDVI),the patients were divided into left ventricular remodeling group(ΔLVEDVI>20%,74 cases)and non-left ventricular remodeling group(ΔLVEDVI≤20%,91 cases).The predictive value of myocardial microcirculation characteristics for left ventricular remodeling in patients with myocardial infarction was evaluated using receiver operating characteristic(ROC)curve.The influencing factors of left ventricular remodeling in patients with myocardial infarction were screened by stepwise regression analysis.A risk prediction model for left ventricular remodeling in patients with myocardial infarction was established and validated.Results:Coronary intervention time,myocardial infarction area,C-reactive protein(CRP),matrix metalloproteinase-9(MMP-9),vascular endothelial growth factor-A(VEGF-A),index of microcirculatory resistance(IMR),fractional flow reserve(FFR),and coronary flow reserve(CFR)were all independent risk factors affecting left ventricular remodeling in patients with myocardial infarction(P<0.05).The calibration curve results showed that the multivariate logistic regression model had good accuracy.Conclusion:Myocardial microcirculation characteristics in patients with myocardial infarction have certain predictive value for left ventricular remodeling.