二维斑点追踪超声心动图对射血分数保留的急性心肌梗死患者左室重构的预测价值

Predictive Value of Two-dimensional Speckle Tracking Echocardiography for Left Ventricular Remodeling in Patients with Acute Myocardial Infarction with Preserved Ejection Fraction

目的 探讨二维斑点追踪超声心动图(two-dimensional speckle tracking echocardiography,2D-STE)对射血分数保留的急性心肌梗死(acute myocardial infarction,AMI)患者左室重构(left ventricular remodeling,LVR)的预测价值。方法 选取2021-01/2023-05月期间作者医院成功完成经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的103例射血分数保留的AMI患者作为研究对象。根据术后6个月超声心动图评估有无LVR,将所有患者分为LVR组(n=28)和非LVR组(n=75)。在PCI后36 h内完成2D-STE检查,记录左心室整体纵向应变(global longitudin strain,GLS)、整体径向应变(global radial strain,GRS)、整体圆周应变(global circumferential strain,GCS)和梗死相关纵向应变(infarct-related longitudinal strain,ILS)。结果 LVR组AMI患者术后36 h肌酸激酶同工酶MB(creatine kinase-MB isoenzyme,CK-MB)、N末端B型利钠肽原(N-terminal pro-B-type natriuretic peptide,NT-proBNP)水平显著高于非LVR组,左心室舒张末期内径(left ventricular end diastolic dimension,LVEDd)、左心室收缩末期容积(left ventricular end-systolic volume,LVESV)水平显著低于非LVR组(P均<0.05)。术后36 h,LVR组AMI患者2D-STE应变参数ILS显著高于非LVR组(P<0.05);随访6个月后,LVR组AMI患者2D-STE应变参数GRS显著低于非LVR组,ILS显著高于非LVR组(P均<0.05)。多因素Logistic回归分析结果显示,CK-MB和ILS是射血分数保留的AMI患者LVR发生的独立预测因子(P<0.05)。受试者工作特征(receiver operating characteristic,ROC)曲线分析结果显示,ILS预测AMI患者发生LVR的预测价值曲线下面积(area under the curve,AUC)为0.862,灵敏度为85.73%,特异度为81.32%,ILS和CK-MB联合预测AMI患者发生LVR的预测价值AUC为0.886,灵敏度为92.89%,特异度为76.00%。结论 2D-STE是LVR预测的一种高效、实用且可靠的非侵入性技术,2D-STE参数ILS是射血分数保留的AMI患者LVR风险的良好预测指标。

Objective To investigate the predictive value of two-dimensional speckle tracking echocardiography(2D-STE) for left ventricular remodeling(LVR) in patients with acute myocardial infarction(AMI) with preserved ejection fraction.Methods A total of 103 AMI patients with preserved ejection fraction who underwent percutaneous coronary intervention(PCI) in author′s hospital from January 2021 to May 2023 were selected as the study subjects.The patients were divided into LVR group(n=28) and non-LVR group(n=75) based on the presence or absence of LVR on postoperative echocardiography at 6 months.2D-STE examination was performed within 36h after PCI,and the global longitudin strain(GLS),global radial strain(GRS) and global circumferential strain(GCS) and infarct-related longitudinal strain(ILS) were recorded.Results The creatine kinase-MB isoenzyme(CK-MB) and N-terminal pro-B-type natriuretic peptide(NT-proBNP) levels 36 h after surgery in AMI patients in LVR group were significantly higher than those in the non-LVR group,and the left ventricular end diastolic dimension(LVEDV) and left ventricular end-systolic volume(LVESV) levels were significantly lower than non-LVR group(all P<0.05).36h after surgery,the ILS of 2D-STE strain parameter in LVR group was significantly higher than that in non-LVR group(P<0.05);after 6 months of the follow-up,the 2D-STE strain parameters GRS of AMI patients in the LVR group was significantly lower and ILS was significantly higher than those in the non-LVR group(all P<0.05).Multivariate Logistic regression analysis showed that CK-MB and ILS were independent predictors of LVR in AMI patients with preserved ejection fraction(P<0.05).The results of receiver operating characteristic(ROC) curve showed that the area under the curve(AUC) of ILS in predicting the occurrence of LVR in AMI patients was 0.862,the sensitivity was 85.73% and the specificity was 81.32%,the predictive value AUC of ILS and CK-MB combined in predicting the occurrence of LVR in AMI patients was 0.886,the sensitivity was 92.89% and the specificity was 76.00%.Conclusion 2D-STE is an efficient,practical and reliable non-invasive technique for LVR prediction,and its parameter ILS is a good predictor of LVR risk in AMI patients with preserved ejection fraction.