三维超声心动图右心室特征对急性左心室下壁心肌梗死患者PCI术后心力衰竭的预测价值
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(潍坊市中医院急诊科,山东省潍坊市 216000)

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郭园园,硕士,主治医师,研究方向为心血管系统疾病、急危重症抢救,E-mail:qpeftx@126net.com.cn。

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Predictive value of right ventricular features on three-dimensional echocardiography for heart failure after PCI in patients with inferior wall myocardial infarction
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Emergency Department, Weifang Hospital of Traditional Chinese Medicine, Weifang, Shandong 216000, China)

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    目的]探究三维超声心动图右心室特征对急性左心室下壁心肌梗死(INFMI)患者经皮冠状动脉介入治疗(PCI)后心力衰竭(HF)的预测价值。 [方法]纳入2018年10月—2021年10月261例INFMI患者,根据PCI术后1年随访记录分为心力衰竭组(n=42)和无心力衰竭组(n=219)。比较两组临床资料和心动图特征;采用LASSO-Logistic回归筛选术后HF发生的独立影响因素;构建列线图模型并验证。 [结果]经筛选,在最优λ值处LASSO模型纳入INFMI患者游离壁中间段和整体纵向应变、流入道舒张期末容积和射血分数、体部舒张期末容积和射血分数。术后体部射血分数降低(截断值43.27%)、流入道射血分数降低(截断值51.49%)、整体纵向应变升高(截断值-13.52%)对HF有较高预测价值。联合年龄、Killip分级、N末端脑钠肽前体(NT-proBNP)构建列线图模型区分度较高,一致性指数0.981(95%CI:0.872~0.997),预测值与实际值拟合度较好。 [结论]INFMI患者右心室整体纵向应变、流入道和体部射血分数联合年龄、Killip分级、NT-proBNP对PCI术后1年HF风险具有较高的预测价值,预测模型可作为临床决策工具使用。

    Abstract:

    Aim To investigate the predictive value of right ventricular features on three-dimensional echocardiography for heart failure (HF) after percutaneous coronary intervention (PCI) in patients with inferior wall myocardial infarction (INFMI). Methods 261 patients with INFMI from October 2018 to October 2021 were included. Patients were divided into heart failure group (n=42) and no heart failure group (n=219) based on one-year follow-up records after PCI. Clinical data and echocardiographic characteristics of the two groups were compared. LASSO-Logistic regression was used to screen the independent influencing factors for the occurrence of postoperative HF. A column-line diagram model was constructed and validated. Results After screening, the LASSO model at the optimal λ value incorporated free wall mid-segment and global longitudinal strain, inflow tract end-diastolic volume and ejection fraction, and body end-diastolic volume and ejection fraction in INFMI patients. Higher predictive value for HF was found in lower postoperative body ejection fraction (cutoff value 43.27%), lower inflow tract ejection fraction (cutoff value 51.49%), and higher global longitudinal strain (cutoff value -13.52%). Ultrasound indices combined with age, Killip classification, and N-terminal pro-brain natriuretic peptide (NT-proBNP) were used to construct a columnar graphical model. The model was highly discriminative, with a consistency index of 0.981 (95%CI:0.872~0.997). The model predicted values fitted well with the actual values. Conclusion Right ventricular global longitudinal strain, inflow tract ejection fraction, body ejection fraction, age, Killip classification, and NT-proBNP in patients with INFMI have a high predictive value for the risk of HF one year after PCI. The jointly constructed prediction model can be used as a clinical decision-making tool.

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郭园园,王雲雲,李海龙.三维超声心动图右心室特征对急性左心室下壁心肌梗死患者PCI术后心力衰竭的预测价值[J].中国动脉硬化杂志,2024,32(2):149~154.

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  • 收稿日期:2023-05-15
  • 最后修改日期:2023-11-23
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  • 在线发布日期: 2024-02-22