摘要
目的:探讨无创心肌做功技术定量评估ST段抬高型心肌梗死(STEMI)患者在经皮冠状动脉介入术(PCI)后左心室收缩功能恢复情况及其预测价值。方法:选取2021年1月—2022年7月我院初发STEMI行急诊PCI治疗的患者59例,根据术后3月左室射血分数(LVEF)较术后24 h内是否增加>5%将患者分为左心室收缩功能恢复组(36例)和未恢复组(23例)。所有患者均应用超声心动图获取常规左心室结构及功能指标,应用自动功能成像技术获取左室整体纵向应变(GLS)与峰值应变离散度(PSD),应用无创心肌做功技术获取左心室整体心肌做功参数:左心室整体有用功(GCW),整体无用功(GWW),做功效率(GWE)以及整体做功指数(GWI)。结果:(1)超声参数分析:各时期两组间LVEF、GLS、GWI、GCW、GWE PSD、GWW具有明显差异性(P<0.05)。与24 h内相比,3月时功能恢复组LVEF、GLS、GCW、GWI、GWE明显升高,GWW、PSD明显减低(P<0.05);功能未恢复组LVEF、GLS、GCW、GWI略升高(P<0.05),PSD、GWW、GWE变化无统计学意义(P>0.05)。(2)相关性分析:GWI、GCW、GWE、GWW分别与LVEF、GLS及PSD之间均具有良好相关性(均P<0.05)。(3)心肌做功参数预测效能:根据ROC曲线显示,GWI(AUC=0.9287,灵敏度为0.913,特异度0.8611)、GWE(AUC=0.8961,灵敏度为0.913,特异度为0.722)及GCW(AUC=0.9251,灵敏度为0.7826,特异度为0.9167)三者均具有较高的AUC(均P<0.05)。结论:无创心肌做功技术可以对STEMI患者的左心室收缩功能进行定量评估,同时对PCI术后3月左心室收缩功能的恢复情况具有良好的预测效能,有助于及早提示患者的左心室收缩功能恢复情况,以便临床对于治疗方案的的选择与调整。
Objective:To explore the predictive value of non-invasive myocardial work technology to quantitatively evaluate the recovery of left heart systolic function after percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction(STEMI).Method:Fifty-nine patients who underwent emergency PCI treatment for STEMI at Shengjing Hospital Affiliated to China Medical University were selected from January 2021 to July 2022.The patients were divided into left ventricular systolic function recovery group(36 cases)and non-recovery group(23 cases),according to whether the left ven-tricular ejection fraction(LVEF)increased by 5%at 3 months compared with in 24 hours.All patients were underwent echocardiography to obtain conventional left heart geometric and functional parameters,automatic functional imaging technology to obtain the global longitudinal strain(GLS)and peak strain dispersion(PSD)of the left ventricle,and non-invasive myocardial work technology to obtain the global myocardial work parameters of the left ventricle:global constructive work(GCW),global wasted work(GWW),global work efficiency(GWE)and global work index(GWI).Results:Analysis of echocardiographic parameters:LVEF,GLS,GWI,GCW,GWE,PSD,GWW were significantly different between the two groups in each period(P0.05).Compared within 24 hours,LVEF,GLS,GCW,GWI,GWE were significantly higher,GWW and PSD were significantly lower in the recovery group in the 3 months(P0.05).LVEF,GLS,GCW,GWI were slightly higher in the non-recovery group(P0.05),and the changes in PSD,GWW and GWE were not statistically significant(P0.05).Correlation analysis:GWI,GCW,GWE,and GWW were well correlated with LVEF,GLS,and PSD respectively(all P0.05).Predictive efficacy of myocardial work parameters:According to the ROC curve,GWI(AUC=0.9287,sensitivity 0.913,specificity 0.8611),GWE(AUC=0.8961,sensitivity 0.913,specificity 0.722)and GCW(AUC=0.9251,sensitivity 0.7826,specificity 0.9167)all three had high area un-der the curve(all P0.05).Conclusion:Noninvasive myocardial
作者
宋卫平
肖杨杰
王传合
孙志军
任卫东
SONG Wei-ping;XIAO Yang-jie;WANG Chuan-he;SUN Zhi-jun;REN Wei-dong(Shengjing Hospital of China Medical University,Shenyang 110004,China)
出处
《中国临床医学影像杂志》
CAS
CSCD
2023年第8期566-570,共5页
Journal of China Clinic Medical Imaging
基金
国家自然科学基金项目(编号:81571686)。
