摘要
目的探究合并胸腔积液的急性心肌梗死(AMI)患者的心肌损伤特点及对远期预后的影响。方法前瞻性连续入选发病15 d内住院且行心脏磁共振成像及心脏彩超检查的AMI患者。按照心脏彩超有无胸腔积液分为有胸腔积液组和无胸腔积液组。比较2组患者基线资料,心脏磁共振心肌损伤指标及心脏彩超特征。通过门诊复诊、电话等方式随访,记录其主要不良心脑血管事件,包括全因死亡、再发心肌梗死、再次冠状动脉血运重建、因心力衰竭再入院及卒中的复合终点。Cox回归分析患者发生全因死亡的影响因素。结果211例中有胸腔积液31例(14.7%),无胸腔积液180例(85.3%)。与无胸腔积液组比较,有胸腔积液组心脏彩超左心室舒张末期直径更大,左心室射血分数更低(P<0.05);心脏磁共振成像示2组患者梗死面积、左心室舒张末期容积、左心室收缩末期容积、左心室射血分数、微循环阻塞及心肌内出血发生率比较差异无统计学意义(均P>0.05)。随访显示43例(20.4%)发生主要不良心脑血管事件,2组比较差异无统计学意义(χ^(2)=3.160,P=0.075);其中6例(2.8%)发生全因死亡,有胸腔积液组全因死亡发生率高于无胸腔积液组(9.7%vs.1.7%,P<0.05),2组的其他不良事件发生率差异均无统计学意义(均P>0.05);多因素Cox回归分析示高龄及发生胸腔积液是随访发生全因死亡的独立危险因素。结论AMI合并胸腔积液患者的心肌损伤更重,全因死亡率更高。
Objective To explore the characteristics of myocardial injury in patients with acute myocardial infarction(AMI)complicated by pleural effusion and its effect on long-term prognosis.Methods It was a prospective single-center study.Patients with AMI who were admitted to hospital within 15 days from symptom onset and performed echocardiography and cardiac magnetic resonance imaging(CMR)during hospitalization were consecutively enrolled and assigned to the withpleural effusion group and the without-pleural effusion group according to the echocardiography result.Baseline data,cardiac magnetic resonance myocardial injury index and echocardiography characteristics were compared between the two groups.The occurrence of major adverse cardiovascular and cerebrovascular events(MACCE)was recorded through outpatient follow-up and telephone follow-up,including all-cause death,re-infarction,revascularization,rehospitalization for congestive heart failure and stroke.Cox regression analysis was performed to analyze influencing factors of all-cause death.Results Among 211 patients,31(14.7%)patients had pleural effusion and 180(85.3%)had no pleural effusion.Compared with the group without pleural effusion,the left ventricular end-diastolic diameter was larger,and left ventricular ejection fraction assessed by echocardiography was lower in the group with pleural effusion(P<0.05).There were no significant differences in infarct size,left ventricular end-diastolic volume,left ventricular end-systolic volume,left ventricular ejection fraction and the presence of microvascular obstruction and intramyocardial hemorrhage between the two groups in CMR(all P>0.05).At a median follow-up of 31 months,MACCE occurred in 43(20.4%)patients,and there was no significant difference between the two groups(χ2=3.160,P=0.075).Six cases(2.8%)had all-cause death.The incidence of all-cause death was higher in the group with pleural effusion than that in the group without pleural effusion(9.7%vs.1.7%,P<0.05).There was no significant difference in the incid
作者
高光仁
冯连荣
付金国
郭润
牛和平
李凤鹏
张倩玉
张军
GAO Guangren;FENG Lianrong;FU Jinguo;GUO Run;NIU Heping;LI Fengpeng;ZHANG Qianyu;ZHANG Jun(Department of Cardiology,Cangzhou Central Hospital,Cangzhou 061000,China;Department of Neurology,Cangzhou Central Hospital,Cangzhou 061000,China)
出处
《天津医药》
CAS
2024年第2期197-201,共5页
Tianjin Medical Journal
基金
河北省医学科学研究课题计划(20210479)
沧州市重点研发计划指导项目(204106134)。
关键词
心肌梗死
胸腔积液
预后
磁共振成像
超声心动描记术
多普勒
彩色
心肌损伤
myocardial infarction
pleural effusion
prognosis
magnetic resonance imaging
echocardiography,Doppler,color
myocardial injury
