| 摘要: |
| 目的 探讨心肌应变参数对急性ST段抬高型心肌梗死（STEMI）患者左心室重构（LVR）的预测价值。方法 序贯入组2018年1月1日至2019年1月31日在上海交通大学附属第六人民医院心血管诊疗中心确诊为STEMI且成功接受急诊经皮冠状动脉介入（PPCI）治疗的81例患者，均分别在急性期（发病7 d内）和起病6个月后进行3.0 T心脏磁共振检查。根据起病6个月后是否发生LVR[第2次心脏磁共振检查测量的左心室舒张末期容积（LVEDV）较基线增加≥20%]将患者分为LVR组（33例）和非LVR组（48例），探究心肌应变相关参数对STEMI患者PPCI术后发生LVR的预测价值。结果 LVR组心肌梗死急性期峰值超敏血清肌钙蛋白I（peak hs-cTnI）水平高于非LVR组，整体纵向应变（GLS）低于非LVR组，梗死区纵向应变达峰时间短于非LVR组，差异均有统计学意义（P均＜0.01）。多因素logistic回归分析显示，peak hs-cTnI（OR＝1.026，95% CI 1.006~1.046，P＝0.012）和梗死区纵向应变达峰时间（OR＝0.967，95% CI 0.950~0.983，P＜0.001）是STEMI患者起病6个月后发生LVR的独立影响因素。ROC曲线分析显示，peak hs-cTnI为85.54 μg/L时，预测STEMI患者起病6个月后发生LVR的灵敏度为60.60%，特异度为97.90%（AUC值为0.795，P＜0.001）；GLS为－10.56%时，预测LVR的灵敏度为81.80%，特异度为70.80%（AUC值为0.761，P＜0.001）；梗死区纵向应变达峰时间取309.12 ms时，预测LVR的灵敏度为87.90%，特异度为87.50%（AUC值为0.926，P＜0.001）。结论 急性期peak hs-cTnI、GLS和梗死区纵向应变达峰时间对成功行PPCI治疗的STEMI患者起病6个月后发生LVR有较高的预测价值，且peak hs-cTnI、梗死区纵向应变达峰时间是LVR的独立影响因素。 |
| 关键词: 急性ST段抬高型心肌梗死 心肌应变 预后 左心室重构 |
| DOI：10.16781/j.CN31-2187/R.20210992 |
| 投稿时间：2021-09-28 |
| 基金项目:上海市2021年度科技创新行动计划医学创新研究专项（21Y11909400），转化医学国家重大科技基础设施（上海）开放课题项目（TMSK-2020-103） |
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| Role of myocardial strain parameters in predicting left ventricular remodeling in patients with acute ST segment elevation myocardial infarction |
| MA Wen-kun1,LI Xin-ni1,GAO Cheng-jie2,GAO Ya-jie1,PAN Jing-wei1* |
(1. Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China;
2. Department of Geriatrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
*Corresponding author) |
| Abstract: |
| Objective To explore the role of myocardial strain parameters in predicting left ventricular remodeling (LVR) in patients with acute ST segment elevation myocardial infarction (STEMI).Methods A total of 81 patients who were diagnosed with STEMI and successfully treated with primary percutaneous coronary intervention (PPCI) in Cardiovascular Clinic of Shanghai Jiao Tong University Affiliated Sixth People's Hospital from Jan. 1, 2018 to Jan. 31, 2019 were sequentially enrolled. Cardiac magnetic resonance at 3.0 Tesla was performed at the acute stage of STEMI (< 7 d) and after 6 months of onset. According to whether LVR (increase of left ventricular end-diastolic volume [LVEDV] measured by the second cardiac magnetic resonance examination ≥20% from baseline) occurred after 6 months of onset, the patients were divided into LVR group (33 cases) and non-LVR group (48 cases). Myocardial strain parameters were evaluated to predict LVR of STEMI patients after PPCI.Results Compared with the non-LVR group, the level of peak hypersensitive serum cardiac troponin I (peak hs-cTnI) at the acute stage of myocardial infarction was significantly higher, the global longitudinal strain (GLS) was significantly lower, and the time to peak longitudinal strain in infarct zone was significantly shorter in the LVR group (all P < 0.01). Multivariate logistic regression analysis showed that peak hs-cTnI (odds ratio [OR]＝1.026, 95% confidence interval [CI] 1.006-1.046, P＝0.012) and time to peak longitudinal strain in infarct zone (OR＝0.967, 95% CI 0.950-0.983, P < 0.001) were independent influencing factors of LVR after 6 months of onset in STEMI patients. ROC curve analysis showed that when the peak hs-cTnI was 85.54 μg/L, the sensitivity and specificity of predicting LVR in STEMI patients after 6 months of onset were 60.60% and 97.90%, respectively (area under curve [AUC] value was 0.795, P < 0.001); when the GLS was －10.56%, the sensitivity and specificity were 81.80% and 70.80%, respectively (AUC value was 0.761, P < 0.001); when the time to peak longitudinal strain in infarct zone was 309.12 ms, the sensitivity and specificity were 87.90% and 87.50%, respectively (AUC value was 0.926, P < 0.001).Conclusion Peak hs-cTnI at acute stage, GLS and time to peak longitudinal strain in infarct zone were valuable in predicting LVR in STEMI patients receiving PPCI treatment after 6 months of onset, and peak hs-cTnI and time to peak longitudinal strain in the infarct zone are independent influencing factors for LVR. |
| Key words: acute ST segment elevation myocardial infarction myocardial strain prognosis left ventricular remodeling |
