实时三维经胸超声心动图联合血清BNP、sST2对心肌梗死后心力衰竭的诊断价值

Diagnostic Value of Real-Time Three-Dimensional Transthoracic Echocardiography Combined with Serum BNP and sST2 in Heart Failure after Myocardial Infarction

目的:探讨实时三维经胸超声心动图(RT3D-TTE)联合血清B型脑钠肽(BNP)、可溶性生长刺激表达基因2蛋白(sST2)对心肌梗死后心力衰竭(HF)的诊断价值。方法:选取2020年6月至2022年11月于广州中医药大学附属中山中医院首次住院的心肌梗死后HF患者88例(HF组),根据Killip分级将患者分为Ⅱ级组(21例),Ⅲ级组(39例),Ⅳ级组(28例)。另选择同期体检的88例健康志愿者为对照组。所有受试者均行RT3D-TTE检查,并检测血清BNP、sST2水平。Spearman秩相关分析Killip分级与RT3D-TTE参数、血清BNP、sST2的相关性,Pearson分析RT3D-TTE参数与血清BNP、sST2的相关性。受试者工作特征曲线(ROC)分析RT3D-TTE参数联合BNP、sST2诊断心肌梗死后HF的价值。结果:HF组左心室收缩末期容量(ESV)、左心室舒张末期容量(EDV)、左室16心肌节段从QRS波起点到最小收缩容积时间的标准差值校正值占心动周期的百分比(Tmsvl6-SD%)和最大差值校正值占心动周期的百分比(Tmsvl6-Dif%)和血清BNP、sST2水平高于对照组(P<0.05),左心室射血分数(LVEF)低于对照组(P<0.05)。Ⅳ级组ESV、EDV、Tmsvl6-SD%、Tmsvl6-Dif%和血清BNP、sST2水平高于Ⅱ级组、Ⅲ级组(P<0.05),LVEF低于Ⅱ级组、Ⅲ级组(P<0.05);Ⅲ级组ESV、EDV、Tmsvl6-SD%、Tmsvl6-Dif%和血清BNP、sST2水平高于Ⅱ级组(P<0.05),LVEF低于Ⅱ级组(P<0.05)。HF组Killip分级与ESV、EDV、Tmsvl6-SD%、Tmsvl6-Dif%和血清BNP、sST2水平呈正相关(P<0.05),与LVEF呈负相关(P<0.05)。ESV、EDV、Tmsvl6-SD%、Tmsvl6-Dif%与血清BNP、sST2水平呈正相关(P<0.05),LVEF与血清BNP、sST2水平呈负相关(P<0.05)。联合ESV、EDV、Tmsvl6-SD%、Tmsvl6-Dif%、LVEF、BNP、sST2诊断诊断心肌梗死后HF的曲线下面积(AUC)为0.908,高于各因素单独诊断。结论:心肌梗死后HF患者RT3D-TTE参数ESV、EDV、Tmsvl6-SD%、Tmsvl6-Dif%和血清BNP、sST2水平增高,LVEF降低,联合检测RT3D-TTE参数和血清BNP、sST2可提高对心肌梗死后HF的诊断价值。

Objective:To investigate the diagnostic value of real-time three-dimensional transthoracic echocardiography(RT3D-TTE)combined with serum B type brain natriuretic peptide(BNP)and soluble growth stimulation expressed gene 2 protein(sST2)in heart failure(HF)after myocardial infarction.Methods:88 HF patients after myocardial infarction(HF group)who were hospitalized for the first time in Zhongshan Traditional Chinese Medicine Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine from June 2020 to November 2022 were selected,patients were divided into grade II group(21 cases),grade III group(39 cases)and grade IV group(28 cases)according to Killip classification.And 88 healthy volunteers who underwent physical examination in our hospital during the same period were selected as control group.All subjects underwent RT3D-TTE examination,and serum BNP and sST2 levels were detected.The correlation between Killip classification and RT3D-TTE parameters,serum BNP and sST2 were analyzed by Spearman rank correlation analysis,the correlation between RT3D-TTE parameters and serum BNP and sST2 were analyzed by Pearson analysis.The value of RT3D-TTE parameters combined with BNP and sST2 in the diagnosis of HF after myocardial infarction was analyzed by receiver operating characteristic(ROC)curve.Results:The left ventricular end-systolic volume(ESV),left ventricular end-diastolic volume(EDV),the percentage of standard difference correction value of the time from the beginning of QRS wave to the minimum systolic volume of the left ventricular 16 myocardial segment of the left ventricle to the cardiac cycle(Tmsvl6-SD%)and the percentage of maximum difference correction value to the cardiac cycle(Tmsvl6-Dif%),serum BNP and sST2 levels in HF group were higher than those in control group(P<0.05),and the left ventricular ejection fraction(LVEF)was lower than that in control group(P<0.05).The levels of ESV,EDV,Tmsvl6-SD%,Tmsvl6-Dif%,serum BNP and sST2 in grade IV group were higher than those in grade II group and grade III group(P<0.05),and LVEF was lower than that in grade II group and grade III group(P<0.05);The levels of ESV,EDV,Tmsvl6-SD%,Tmsvl6-Dif%,serum BNP and sST2 in grade III group were higher than those in grade II group(P<0.05),and LVEF was lower than that in grade II group(P<0.05).Killip classification was positively correlated with ESV,EDV,Tmsvl6-SD%,Tmsvl6-Dif%,serum BNP and sST2 levels in HF group(P<0.05),and negatively correlated with LVEF(P<0.05).ESV,EDV,Tmsvl6-SD%and Tmsvl6-Dif%were positively correlated with serum BNP and sST2 levels(P<0.05),and LVEF was negatively correlated with serum BNP and sST2 levels(P<0.05).The area under the curve(AUC)of ESV,EDV,Tmsvl6-SD%,Tmsvl6-Dif%,LVEF,BNP and sST2 in the diagnosis of HF after myocardial infarction was 0.908,which was higher than that of each factor alone.Conclusion:The RT3D-TTE parameters ESV,EDV,Tmsvl6-SD%,Tmsvl6-Dif%,serum BNP and sST2 levels increased and LVEF decreased in HF patients after myocardial infarction,and combined detection of RT3D-TTE parameters,serum BNP and sST2 could improve the diagnostic value of HF after myocardial infarction.