Prognostic value of the echocardiographic right/left ventricular end-diastolic diameter ratio in patients with idiopathic pulmonary arterial hypertension

Background Previous studies have shown that an echocardiographic right/left ventricular end-diastolic diameter ratio(RV/LV ratio)≥0.9 is an independent predictor of poor prognosis in patients with acute pulmonary embolism. The prognostic value of the RV/LV ratio in patients with idiopathic pulmonary arterial hypertension(IPAH) is still unknown. Methods We retrospectively enrolled 95 consecutive patients with newly diagnosed IPAH and 16 of them were reevaluated by echocardiography at 3-12 months following targeted therapy.Follow-up data were obtained by telephone interviews and review of the patients’ records.Results The RV/LV ratio was in parallel with the severity of World Health Orgnization(WHO) functional class and mean right atrial pressure.The RV/LV ratio was positively correlated with total pulmonary resistance(P P P 2 saturation(P P = 0.001),weight and absence of targeted therapy were independent predictors of death.No significant changes in the RV/LV ratio before and after targeted therapy were observed. A baseline RV/LV ratio≥0.84 or a further increase in the RV/LV ratio during targeted therapy indicated a poor prognosis. Conclusions The RV/LV ratio helps to assess the severity of IPAH and serves as an independent predictor of prognosis in patients with IPAH.

The Hidden Value of Assessing Right Ventricular Performance with Exercise in Hypertensive Patients with Left Ventricular Diastolic Dysfunction

Background: Right ventricular (RV) dysfunction could develop during exercise in patients with both hypertension and left ventricular diastolic dysfunction and may contribute to the patient symptoms. The objective is to assess RV function, both at rest and during exercise in patients with hypertension and left ventricular diastolic dysfunction. Methods: We included 30 patients with hypertension and resting LV diastolic dysfunction. The systolic function of the right ventricle was assessed by TAPSE (Tricuspid Annular Plane Systolic Excursion) and S, while E/A ratio, annular lateral E’, E/E’ and E’/A’ were used to measure diastolic function. The global function of the right ventricle was assessed by measuring the right indexed myocardial performance. The dimensions and pulmonary pressures were also measured. Results: The following parameters of RV systolic function were increased significantly with exercise: TAPSE (P = 0.0054), S’ (P = 0.0045). Moreover, the following diastolic parameters of the RV increased significantly with exercise: E/E’ (P = 0.05), A’ (P = 0.04). The global RV function showed also a significant increase (P = 0.0011). The three RV dimensions as well as the pulmonary artery pressures also increased during exercise (P = 0.000004, 0.001, and 0.00000064 respectively). In addition, the presence of resting LV grade II DD predicted significantly higher pulmonary pressures during exercise (P = 0.006). The advanced resting grade of LVDD predicted significantly the presence of advanced grade of RVDD with exercise (P = 0.037). Conclusions: Some patients who have both hypertension and LV diastolic dysfunction showed structural and functional changes of the right ventricle at rest. However, all patients had RV functional changes during exercise.

Effect of exercise on left and right ventricular ejection fraction and wallmotion in patients with coronary artery disease: an ultrafast computed tomography study

To measure the response of left and right ventricular ejection fraction and wall motion to exercise in eighteen patients with angiogl’aphically documented coronary artery disease (CAD) and in twenty-two patients with angiographicallynormal coronary arteries using ultrafast computed tomography(UFCT). Methods: Angiography and UFCT exercise cine studieswere performed for the evaluation of chest pain in all 40 cases, including 18 CAD patients and 22 patients with normal coronary arteries. Results: Of the 18 patients with CAD, 14(78% ) had a≥5% decrease in left ventricular ejection fraction (LVEF) duringexercise by UFCT (P< 0 .001), and 14 (78%) had an abnormal response in left ventricular wall motion during exercise, (aworsened or newly-developed reginal RV wall motion abnormality (RVWMA)) during exercise. In the 22 normal patients, onlyone had a decrease in LVEF > 5%; none had an abnormal response in LV wall motion during peak exercise or a RVWMA at restor during stress. Using a decrease of ≥5 % in LVEF or a LVWMA or RVWMA during stress as a criterion for identifying patientswith CAD, the accuracy was 88% (35/40) with LVEF, 90% (36/40) with LVWMA, and 92% (37/40) with a combination ofLVEF, LVWMA and RVWMA. The sensitivity of RVWMA alone in detecting right coronary artery disease (RCAD) was 60%(6/10) and the specificity was 78% (7/9). Conclusion: Our study suggests that exercise-UFCT appears to be a useful tool for thedetection of CAD in patients with chest pain. The abnormal response of LVEF and exercise-induced LVWMA and RVWMA as determined by UFCT were important predictors CAD. Both LVWMA and RVWMA of important value in identifying patientswith CAN from those with normal coronary arteries, as is RVWMA in defining the existence of RCAD in patients with CAD.

Simultaneous ramp right heart catheterization and echocardiography in a Reliant Heart left ventricular assist device

Many clinicians caring for patients with continuous flow left ventricular assist devices(CF-LVAD) use ramp right heart catheterization(RHC) studies to optimize pump speed and also to troubleshoot CF-LVAD malfunction. An investigational device,the Reliant Heart Heart Assist 5(Houston,TX),provides the added benefit of an ultrasonic flow probe on the outflow graft that directly measures flow through the CF-LVAD. We performed a simultaneous ramp RHC and echocardiogram on a patient who received the above CF-LVAD to optimize pump parameters and investigate elevated flow through the CF-LVAD as measured by the flow probe. We found that the patient's hemodynamics were optimized at their baseline pump speed,and that the measured cardiac output via the Fick principle was lower than that measured by the flow probe. Right heart catheterization may be useful to investigate discrepancies between flow measured by a CF-LVAD and a patient's clinical presentation,particularly in investigational devices where little clinical experience exists. More data is needed to elucidate the correlation between the flow measured by an ultrasonic probe and cardiac output as measured by RHC.

Left Ventricular Pseudoaneurysm Caused by a Left Ventricular Venting Catheter via the Right Superior Pulmonary Vein during Thoracic Aortic Surgery: A Case Report

A left ventricular (LV) pseudoaneurysm is one of the complications of acute myocardial infarction. It is also reported after chest trauma, cardiac surgery, and endocarditis. We report a rare case of an LV pseudoaneurysm induced by an LV venting catheter through the right superior pulmonary vein during thoracic aortic surgery. A 77-year-old man was referred for surgical repair of a distal aortic arch aneurysm. He underwent total aortic arch reconstruction with the frozen elephant trunk technique. The early postoperative period was uneventful. Postoperative contrast computed tomography and transthoracic echocardiography (TTE) revealed a pseudoaneurysm with a narrow neck at the apex of the LV that had sub-clinically progressed. Because of the risk of spontaneous rupture, an urgent aneurysmectomy was performed via a repeat sternotomy. Under cardioplegic arrest, the pseudoaneurysm was opened and the small orifice, which communicated with the LV, was confirmed. No myocardial ischemic changes were observed around the orifice. The pseudoaneurysm was thought to be induced by endocardial laceration by the tip of the venting catheter. The pseudoaneurysm was closed by linear repair reinforced with felt strips. The patient recovered well and was discharged 18 days after the second surgery. TTE showed no recurrence of LV aneurysm at the last follow-up.

A Case of Premature Ventricular Complexes from the Proximal Left Bundle Branch Successfully Ablated from the Right Coronary Cusp

Background:Premature ventricular complexes(PVCs)from the proximal left bundle branch(LBB)can be ablated in the left ventricular outflow tract but can easily damage normal conduction bundles.Here,we report a case of successful ablation of PVCs from the proximal LBB within the right coronary cusp(RCC).Case presentation:Our patient was a 70-year-old woman with PVCs from the proximal LBB that were successfully ablated via the RCC through radiofrequency catheter ablation with a 3D mapping system;she had a complication of incomplete right bundle branch block(RBBB)and remained asymptomatic during follow-up.Conclusion:The RCC provides an alternative approach for ablating PVCs originating from the proximal LBB,ow-ing to the close relationship between the RCC and proximal LBB.

Right Ventricular Failure Following Left Ventricular Assist Device Implantation

Left ventricular assist device (LVAD) is being used increasingly in recent years for end stage heart failure as a bridge to transplant (BTT) and also as a destination therapy (DT). Patients with end stage heart failure have some degree of elevated pulmonary capillary wedge pressure, causing right ventricular hypertrophy which in due course leads to decreased dilatation of the RV and fall in cardiac output & severe tricuspid regurgitation (TR) presenting with features of RV failure (RVF). Implantation of LVAD improves left heart function at the cost of right ventricular output with an incidence of 25%-30%. RVF may lead to impaired LVAD flow, difficulty in weaning from cardio-pulmonary bypass (CPB), decreased tissue perfusion and multi-organ failure. In this article we comprehended the pathophysiology leading to RVF post LVAD implantation and its preoperative predictors and the various treatment modalities for managing RVF post LVAD implantation.

A Heterozygous Phospholamban Variant(p.R14del)Leads to Left Ventricular Involvement and Heart Failure Phenotypes in Arrhythmogenic Right Ventricular Cardiomyopathy

This study aimed to determine the prevalence and clinical features of Arrhythmogenic Right Ventricular Cardiomyopathy(ARVC)caused by pathogenic mutations in the Phospholamban(PLN)gene.The study included 170 patients who had a confrmed diagnosis of ARVC and underwent PLN genetic screening using next-generation sequencing.The fndings of this study provide valuable insights into the association between PLN mutations and ARVC,which can aid in the development of more efective diagnostic and treatment strategies for ARVC patients.Out of the patients evaluated,six had a rare pathogenic mutation in PLN with the same p.R14del variant.Family screening revealed that heterozygous carriers of p.R14del exhibited a defnite ARVC phenotype.In clinical studies,individuals with the p.R14del mutation experienced a similar rate of malignant arrhythmia events as those with classic desmosome mutations.After adjusting for covariates,individuals with PLN mutations had a two point one seven times greater likelihood of experiencing transplant-related risks compared to those who did not possess PLN mutations(95%CI 1.08–6.82,p=0.035).The accumulation of left ventricular fat and fbers is a pathological marker for ARVC patients with p.R14del mutations.In a cohort of 170 Chinese ARVC patients,three point fve percent of probands had the PLN pathogenic variant(p.R14del)and all were female.Our data shows that PLN-related ARVC patients are at high risk for ventricular arrhythmias and heart failure,which requires clinical diferentiation from classic ARVC.Furthermore,carrying the p.R14del mutation can be an independent prognostic risk factor in ARVC patients.

Right ventricular septal pacing: Safety and efficacy in a long term follow up

AIM: To evaluate the safety and efficacy of the permanent high interventricular septal pacing in a long term follow up, as alternative to right ventricular apical pacing. METHODS: We retrospectively evaluated:(1) 244 patients(74 ± 8 years; 169 men, 75 women) implanted with a single(132 pts) or dual chamber(112 pts) pacemaker(PM) with ventricular screw-in lead placed at the right ventricular high septal parahisian site(SEPTAL pacing);(2) 22 patients with permanent pacemaker and low percentage of pacing(< 20%)(NO pacing);(3) 33 patients with high percentage(> 80%) right ventricular apical pacing(RVA). All patients had a narrow spontaneous QRS(101 ± 14 ms). We evaluated New York Heart Association(NYHA) class, quality of life(Qo L), 6 min walking test(6MWT) and left ventricular function(end-diastolic volume, LV-EDV; end-systolic volume, LVESV; ejection fraction, LV-EF) with 2D-echocardiography. RESULTS: Pacing parameters were stable duringfollow up(21 mo/patient). In SEPTAL pacing group we observed an improvement in NYHA class, Qo L score and 6MWT. While LV-EDV didn't significantly increase(104 ± 40 m L vs 100 ± 37 m L; P = 0.35), LV-ESV slightly increased(55 ± 31 m L vs 49 ± 27 m L; P = 0.05) and LV-EF slightly decreased(49% ± 11% vs 53% ± 11%; P = 0.001) but never falling < 45%. In the RVA pacing control group we observed a worsening of NYHA class and an important reduction of LV-EF(from 56% ± 6% to 43% ± 9%, P < 0.0001).CONCLUSION: Right ventricular permanent high septal pacing is safe and effective in a long term follow up evaluation; it could be a good alternative to the conventional RVA pacing in order to avoid its deleterious effects.

The Prevalence and Short-Term Outcomes of Ventricular Dyssynchrony after Right Ventricular Pacing

Objective: Long-term right ventricular pacing has been associated with an increased risk of heart failure and cardiomyopathy. The pathophysiology of cardiomyopathy associated with right ventricular pacing remains unclear. We aim to evaluate the burden and short-term outcomes of ventricular dyssynchrony after immediate permanent pacemaker implantation. Materials and Methods: This prospective cohort study examined consecutive patients who had permanent pacemaker implantation at Vajira Hospital in 2019. Left ventricular systolic function, specifically left ventricular ejection fraction (LVEF) and echocardiographic ventricular dyssynchrony parameters were assessed. The endpoints included the prevalence of ventricular dyssynchrony, new-onset cardiomyopathy, heart failure, and death. The correlation between QRS complex duration, the burden of ventricular pacing, and echocardiographic ventricular dyssynchrony was measured. Results: Thirty-six consecutive patients underwent pacemaker implantation. The prevalence of mechanical ventricular dyssynchrony was 22.2% using the interventricular conduction delay method, 41.7% using LV pre-ejection period method, and 11.1% using the septal posterior wall motion abnormality method. Electrical ventricular dyssynchrony was 86.1% and new-onset cardiomyopathy was 17.1% after 3 months of permanent pacemaker implantation. The right ventricular pacing of more than 20% was significantly associated with cardiomyopathy (p < 0.022) and heart failure (log-rank, p = 0.049) within 3 months. But heart failure was not associated with mechanical ventricular dyssynchrony parameters (log-rank, p = 0.610;hazard ratio [HR], 1.53;95% confidence interval [CI], 0.29 - 7.96;p = 0.613 for IVMD and log-rank, p = 0.398;HR, 0.04;95% CI, 0.01 - 3316.7 for SPWMD). Conclusion: Mechanical and electrical ventricular dyssynchrony are common findings in right ventricular pacing. High-burden right ventricular pacing after 3 months of permanent pacemaker implantation is often associated with cardiomyopathy and heart failure, but mechanical and electrical ventricular dyssynchrony does not predict a short-term decline in left ventricular systolic function and heart failure.

Ⅰ导联R/(R+S)对胸前V3导联移行流出道室性心律失常起源部位的鉴别价值

目的:探索鉴别胸前V3导联移行流出道室性心律失常(OT-VA)起源部位的体表心电图指标。方法:连续选择2017年1月至2022年8月行导管射频消融术的胸前V3导联移行OT-VA患者65例。比较左室流出道起源组(LVOT组)和右室流出道起源组(RVOT组)室性心律失常发作时体表心电图QRS波振幅及相关指标的差异,选择差异有统计学意义的指标,绘制ROC曲线评价所选取指标鉴别OT-VA起源部位的效能。结果:LVOT组11例,RVOT组54例,两组间差异有统计学意义且ROC曲线下面积(AUC)最大的指标为Ⅰ导联R波/(R+S)波振幅比[R/(R+S)],其鉴别OT-VA起源部位的AUC(95%CI)为0.949(0.894~1.000),截断值为0.50。Ⅰ导联R/(R+S)<0.50诊断胸前V3导联移行LVOT起源OT-VA的敏感度、特异度和准确度分别为0.909、0.944和0.938。结论:Ⅰ导联R/(R+S)<0.50可准确鉴别LVOT起源的胸前V3导联移行OT-VA。

应激性高血糖比值对围产期心肌病患者预后的预测价值

目的探讨应激性高血糖比值(SHR)对围产期心肌病(PPCM)患者预后的预测价值。方法连续性收集2007年1月至2023年3月于首都医科大学附属北京安贞医院住院治疗诊断为PPCM的78例患者的临床资料进行回顾性分析。根据心功能是否改善分为无改善组(37例)和改善组(41例)。使用受试者工作特征(ROC)曲线分析SHR对患者不良预后的预测效能,采用Logistic回归分析方法评估心功能无改善的影响因素。结果无改善组患者年龄、经产妇比例、PPCM病史比例、左心室舒张末期内径、血肌酐、血糖、B型脑钠肽水平、SHR均大于/高于改善组,收缩压、左心室射血分数(LVEF)均低于改善组(均P<0.05)。ROC曲线分析结果显示,SHR预测PPCM患者出现不良预后的最佳截断值为1.079,敏感度为81.1%,特异度为90.2%,曲线下面积为0.880(95%置信区间:0.800~0.961)(P=0.041)。多因素Logistic回归分析结果显示SHR≥1.079、血肌酐及LVEF<35%为PPCM患者不良预后的独立危险因素(均P<0.05)。结论SHR≥1.079是PPCM患者预后不良的危险因素,使用SHR可以协助识别PPCM高危人群。

Validation of real-time three-dimensional echocardiography for quantifying left and right ventricular volumes:an experimental study

Background Assessment of the left ventricular (LV) and the right ventricular (RV) volumes and their functions is important for prognostic prediction and clinical decision making. We compared the accuracy for quantifying the LV and the RV volumes in vitro between conventional two-dimensional echocardiography (2DE) and real-time three-dimensional echocardiography (RT3DE) Methods The volumes of 37 rubber-models (10 regularly shaped to simulate normal LV, 7 shaped to simulate LV with symmetric aneurysm, 8 shaped to simulate LV with asymmetric aneurysm, and 12 irregularly shaped to simulate normal RV) and 10 excised canine hearts were measured by RT3DE and 2DE On RT3DE 'full volume' imaging, the inner-surfaces of the rubber-models and canine LV and RV were outlined and the volumes were measured using 2-, 4-, 8- and 16-plane methods with the RT3DE analysis software On 2DE imaging, the volumes were measured by the Simpson method The LV and RV volumes measured by drained water were served as reference values, with which we compared RT3DE and 2DE data Results In rubber models mimicking normal LV and LV with symmetric aneurysms, RT3DE results were strongly correlated with reference values ( r =0 795-0 998) and there was a good correlation between 2DE estimates and reference values ( r =0 715-0 729) There were no significant differences between RT3DE estimates, 2DE results and reference values ( P >0 05) In rubber models mimicking the RV and LV with asymmetric aneurysm, RT3DE strongly correlated with reference values ( r =0 765-0 988), but 2DE weakly correlated with reference values ( r =0 518-0 592) There were no differences between RT3DE and reference values ( P >0 05), but a significant difference between 2DE and reference values occurred ( P <0 05) For excised canine hearts, there was a strong correlation between RT3DE and reference values ( r =0 728-0 914), while 2DE showed a less obvious correlation ( r =0 502-0 615) Again, there were no significant differences between RT3DE and reference values ( P >0 05), but there was a significant difference between 2DE and reference values ( P <0 05) Conclusions RT3DE can accurately quantify LV and RV volumes and provides a new tool to evaluate LV and RV function For LV and RV measurements by RT3DE, 8-plane strategy is the optimum choice for accuracy and convenience

左束支区域起搏对房室传导阻滞患者术后新发房性心律失常的影响

目的探讨左束支区域起搏(left bundle branch area pacing,LBBaP)对房室传导阻滞(AVB)患者术后新发心房颤动(new-onset atrial fibrillation,NOAF)和心房高频事件(atrial high rate episodes,AHREs)的影响。方法回顾性纳入84例行起搏治疗的三度房室传导阻滞(ⅢAVB)患者,根据心室电极位置分为LBBaP组(n=42)和右室间隔部起搏(RVSP)组(n=42)。比较两组患者术前术后QRS波时限(QRSd)、心室起搏参数,并发症、脑卒中事件和NOAF、AHREs发生率。结果(1)LBBaP组术后NOAF、AHREs发生率均低于RVSP组(P<0.05)。(2)LBBaP组的p-QRSd短于RVSP组(P<0.05)。(3)两组患者心室起搏参数、并发症及脑卒中事件发生率之间差异无统计学意义(P>0.05)。结论相对于右室起搏,LBBaP术后AHREs、NOAF的发生率较低,可改善患者预后。

1例左心室辅助装置植入术后发生右心衰竭 病人的护理

总结1例左心室辅助装置(left ventricular assist device,LVAD)植入术后发生右心衰竭及心律失常病人的护理措施。护理要点包括负平衡液体管理、实施人体成分分析、体重监测;LVAD参数的监测与调整;使用坐标图及远程监护仪动态监测病情变化;电解质管理;胶体渗透压管理;抗凝管理;用药护理及延续性护理。本例病人经过22 d的精心治疗与护理,顺利康复出院,出院后定期随访病人生存质量良好。

尼可地尔联合瑞舒伐他汀钙治疗冠状动脉慢血流患者的效果观察

目的探讨尼可地尔联合瑞舒伐他汀钙对冠状动脉慢血流(CSF)患者单核细胞与高密度脂蛋白胆固醇比值(MHR)、系统免疫炎症指数(SII)和心功能等的影响。方法采用成组病例对照研究方法,选取240例经冠状动脉造影检查证实CSF患者作为研究对象,随机分为观察组和对照组,每组120例。在常规药物治疗基础上,对照组采用瑞舒伐他汀钙治疗,观察组采用尼可地尔联合瑞舒伐他汀钙治疗,2组均治疗6个月。比较2组患者的临床疗效、炎症指标[超敏C反应蛋白(hs-CRP)、MHR、SII]水平、冠状动脉主要分支[左前降支(LAD)、左回旋支(LCX)、右冠状动脉(RCA)]的校正TIMI帧数(CTFC)、心功能指标[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室整体纵向应变(GLS)]和主要不良心血管事件(MACE)发生情况。结果观察组总有效率为95.00%,高于对照组的80.00%,差异有统计学意义(P<0.05)。治疗后,2组心绞痛发作持续时间缩短、疼痛程度减轻、发作次数减少,且观察组变化程度大于对照组,差异有统计学意义(P<0.05)。治疗6个月后,2组血清hs-CRP、MHR、SII均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗6个月后,2组LAD、LCX、RCA的CTFC均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗6个月后,2组LVEF、GLS绝对值均高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05),但2组LVEDD差异无统计学意义(P>0.05)。2组MACE发生情况比较,差异无统计学意义(P>0.05)。结论将尼可地尔联合瑞舒伐他汀钙应用于CSF患者的治疗中,能显著提升治疗总有效率,降低hs-CRP、MHR、SII水平,改善LVEF、LVEDD、GLS等心功能指标,并有效减轻心绞痛发作程度。

希浦系统起搏对心功能影响的研究进展

心脏起搏是心脏起搏、传导功能障碍及严重心力衰竭的有效治疗手段,但传统右心室起搏可增加心力衰竭、心房颤动发生率,双心室起搏具有相对较高的无应答率。近年来多项研究显示,希浦系统起搏作为生理性起搏新技术,起搏参数稳定,心脏同步性好。本文就目前希浦系统起搏对心功能影响的研究现状及进展进行综述,为促进希浦系统起搏技术发展提供理论依据。

右心室-肺动脉耦合在心血管疾病中的临床应用进展

右心室-肺动脉耦合是指右心室与肺动脉之间相互作用的关系,由右心室收缩功能参数与肺动脉弹性参数的比率来定义,在心血管疾病的临床应用中具有重要的参考价值。目前可通过有创性检测和无创性检查两种方法来评估右心室-肺动脉耦合。现就近年来右心室-肺动脉耦合在心血管疾病中的临床应用进展做一综述。

中性粒细胞与高密度脂蛋白胆固醇比值对急性心肌梗死病人院内主要心血管不良事件的预测价值

目的探讨中性粒细胞与高密度脂蛋白胆固醇(HDL-C)的比值(NHR)对AMI病人发生院内MACE的预测价值以及NHR与Gensini评分量化的冠状动脉病变严重程度、左室射血分数(LVEF)量化的心脏泵功能的潜在关联。方法纳入2018年1月至2022年1月东南大学附属中大医院住院并接受冠状动脉造影的546例AMI病人。收集人口统计学数据、临床资料及计算Gensini评分,依据住院期间是否发生MACE,分为MACE组(n=105)和非MACE组(n=441)。使用受试者操作特征曲线(ROC曲线)检验NHR预测院内MACE的能力,并确定最佳截断值。使用多因素logistic回归分析院内MACE的影响因素,同时,采用线性回归分析NHR对Gensini评分、LVEF值的影响,并通过Graphpad prism绘图进行可视化处理。院内MACE定义为:住院死亡、心源性休克、致血流动力学紊乱的恶性心律失常(包括室颤、持续性室速、高度及三度房室传导阻滞)等。结果MACE组的NHR[13.64(9.89,18.19)]显著高于非MACE组[7.73(5.83,10.07)],并且NHR对AMI病人院内MACE具有较强的预测价值[AUC:0.84,95%CI:(0.79,0.88),P<0.001],调整混杂因素后,多因素二元logistic回归分析显示NHR是AMI病人院内MACE的独立危险因素[OR:1.29,95%CI:(1.16,1.43),P<0.001]。线性回归分析显示NHR与AMI病人Gensini评分呈显著正相关(P<0.001),与LVEF呈显著负相关(P<0.001)。结论本研究证实NHR是AMI病人院内MACE的有力预测指标,是院内MACE的独立危险因素之一,与Gensini评分量化的冠状动脉病变严重程度呈显著正相关,与LVEF量化的心脏泵功能呈显著负相关,可用于早期识别AMI病人院内MACE的高危人群,辅助临床诊疗。