左室心肌做功与STEMI患者急诊PCI术后出现左室重构的相关性研究-东南大学学报医学版

左室心肌做功与STEMI患者急诊PCI术后出现左室重构的相关性研究

单位：1. 苏州大学附属张家港医院/张家港市第一人民医院心血管内科, 江苏张家港 215600;
2. 苏州大学附属张家港医院/张家港市第一人民医院急诊科, 江苏张家港 215600

关键词：左室心肌做功左室整体做功指数急性ST段抬高型心肌梗死经皮冠脉介入术左室重构

分类号：R542.22

出版年·卷·期（页码）：2024·43·第一期（78-84）

摘要：

目的: 探讨左室心肌做功与急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠脉介入术(PCI术)后出现左室重构的相关性。方法: 自2019年1月到2020年12月连续纳入行急诊PCI术后的54例STEMI患者[男45例,(59.7±12.4)岁],分别在术后48 h以及术后6个月行常规心超、斑点追踪超声以及左室心肌做功检查,测得常规心超数据、左室纵向应变和左室心肌做功各指标,以术后6个月左室舒张末期容积增大≥ 15%作为左室重构的标准,探讨左室心肌做功与左室重构的相关性。结果: 17例患者在术后6个月出现左室重构,左室重构患者组48 h的左室整体做功指数明显低于左室无重构组[(1099.7±426.1)mmHg% vs.(1582.3±557.6) mmHg%,P=0.003]。多因素回归分析显示,48 h左室整体做功指数是行急诊PCI术后的STEMI患者出现左室重构的独立危险因素。ROC曲线下面积为0.757(95%CI为0.622~0.891,截点为1382 mmHg%,特异度为64.9%,敏感度为82.4%,P=0.035)。结论: 48 h左室整体做功指数是行急诊PCI术后STEMI患者出现左室重构的独立危险因素。

Objective: To explore the correlation analysis of left ventricular global myocardial work(LVGMW) and left ventricular remodeling(LVR) after emergency percutaneous coronary intervention(PCI) in patients with acute ST-segment elevation myocardial infarction(STEMI). Methods: From January 2019 to December 2020,54 consecutive patients(45 males) who underwent emergency PCI for AMI were included with an average age of(59.7±12.4) years old. Comprehensive echocardiography was performed for patients who underwent emergency PCI for STEMI 48 hours(48 h) and 6 months after PCI. Left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV),left ventricular global longitudinal strain(LVGLS) and left ventricular global work indices(LVGWI) were assessed. Left ventricle(LV) remodeling(LVR)was defined as an increase of 15% of LVEDV from 48 hours to 6 months after surgery. Multivariate Logistic regression analysis was used to evaluate the correlation of LVGMW and LVR. Results: Left ventricular remodeling occurred in 17 patients at 6 months after surgery. 48 h left ventricular global work index(LVGWI) in the LVR group was significantly lower than that in non-LVR group[(1 099.7±426.1)mmHg% vs.(1 582.3±557.6)mmHg%,P=0.003]. Multivariate Logistic regression analysis showed that LVGWI within 48 h was an independent risk factor for LVR after emergency PCI in STEMI patients,the area under ROC curve was 0.757(95%CI 0.622-0.891,cut-off point 1 382 mmHg%,specificity 64.9%,sensitivity 82.4%,P=0.035).Conclusion: Lower 48 h LVGWI was an independent risk factor for LVR in STEMI patients undergoing emergency PCI.

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