右心室收缩功能对急性前壁ST段抬高型心肌梗死的预后价值

Prognostic value of right ventricular systolic function in acute anterior ST-segment elevation myocardial infarction

目的:本研究探讨右心室收缩功能障碍(right ventricular systolic dysfunction,RVSD)对接受PCI治疗急性前壁ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者预后的影响。方法:本研究纳入了356例经PCI治疗的急性前壁STEMI患者。根据出院前超声心动图检查结果,将三尖瓣环平面收缩期位移(tricuspid annular plane systolic displacement,TAPSE)<17mm或三尖瓣环收缩期峰值速度(tricuspid annular peak systolic velocity,TAPSV)<9.5cm/s定义为RVSD,并将患者分为RVSD组和非RVSD组。比较两组2年随访期间临床事件发生情况,并采用Cox回归模型分析影响患者预后的因素。结果:两组患者在临床特征以及冠状动脉造影和介入治疗特征方面组间对比,差异无统计学意义(P均>0.05)。偏相关分析可知,LVEF与TAPSE呈显著正相关(r=0.132,P=0.012),与TAPSV呈显著正相关(r=0.121,P=0.023)。在2年临床随访期间,预期心力衰竭发生率(Log-rank P=0.015)和全因死亡率(Log-rank P=0.015),差异存在统计学意义。RVSD组和非RVSD组,术后2年预期无主要不良心脏事件(major adverse cardiac events,MACE)累积生存率分别为79.2%和84.1%(Log-rank P=0.041)。多因素Cox回归分析显示,TAPSE(HR=0.456;95%CI:0.223~0.931;P=0.031)为预测2年MACE发生的独立因素。结论:在经PCI治疗的急性前壁STEMI患者中,伴有RVSD的患者MACE发生率明显升高,2年预期无MACE事件累积生存率明显低于不伴RVSD的患者。

Objective:This study explores the impact of right ventricular systolic dysfunction(RVSD)on the prognosis of acute anterior ST-segment elevation myocardial infarction(STEMI)patients treated with PCI.Methods:A total of 356 patients with acute anterior STEMI who underwent primary PCI were enrolled in the study.Based on the characteristics of pre-discharge echocardiography,tricuspid annular plane systolic displacement(TAPSE)<17 mm or tricuspid annular peak systolic velocity(TAPSV)<9.5 cm/s were defined as RVSD,and the patients were divided into RVSD group and non-RVSD group.Compare the clinical outcomes during the 2-year follow-up period between the two groups,and analyze the prognostic factors using Cox regression model.Results:There was no statistically significant difference between the two groups in terms of clinical features,coronary angiography and interventional treatment characteristics(P>0.05).Partial correlation analysis revealed a significant positive correlation between LVEF and TAPSE(r=0.132,P=0.012),as well as a significant positive correlation with TAPSV(r=0.121,P=0.023).During the 2-year follow-up period,there was a statistically significant difference in the estimated outcome rate of heart failure(log rank P=0.015)and all-cause mortality(log rank P=0.015)between the two groups.The cumulative survival rates without major adverse cardiac events(MACE)events at 2-year follow-up in the RVSD group and non-RVSD group were 79.2%and 84.1%,respectively(log rank P=0.041).Multivariate Cox regression analysis showed that TAPSE(HR=0.456;95%CI:0.223-0.931;P=0.031)was an independent predictor of the occurrence of MACE defined in this study at 2-year follow-up.Conclusions:In patients with acute anterior STEMI treated with PCI,the incidence of MACE is significantly increased in patients with RVSD,and the cumulative survival rate without MACE events is significantly lower than in patients without RVSD at 2-year follow-up.