Predictive value of myocardial mechanical parameters of spot tracking stratified strain technique on the short-term prognosis after PCI for myocardial infarction
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摘要:
目的 采用超声斑点追踪(STI)分层应变技术检测心肌梗死(MI)患者心肌力学参数，并探究其对经皮冠状动脉介入治疗(PCI)术后短期预后的预测价值。 方法 选取2022年6月—2023年10月黄河三门峡医院收治的180例行PCI术的MI患者(MI组)及40例同期健康者(对照组)。根据短期预后将MI患者分为预后良好组(133例)和预后不良组(47例)，采用ROC曲线分析心肌力学参数对PCI术后短期预后的预测价值。 结果 MI组左室射血分数，左室整体内、中、外层纵向应变(GLS-endo、GLS-mid、GLS-epi)及环向内、中、外层应变(GCS-endo、GCS-mid、GCS-epi)低于对照组，左心室收缩期容积及舒张末期容积高于对照组(P < 0.05)；预后不良组左室整体内、中、外层纵向应变及环向内、中、外层应变低于预后良好组(P < 0.05)。Logistic回归分析显示，Killip Ⅲ级、6~12 h开通罪犯血管是短期预后不良的危险因素，GLS-endo、GCS-endo高水平是其保护因素(P < 0.05)。ROC分析结果显示，GLS-endo、GCS-endo联合的预测效能高于单独检测(Z=2.019，P=0.044；Z=2.624，P=0.006)。 结论 GLS-endo、GCS-endo是MI患者PCI术后短期预后的影响因素，二者联合对短期预后不良的预测价值较高。 -
关键词:
- 心肌梗死 /
- 斑点追踪分层应变技术 /
- 经皮冠状动脉介入术 /
- 心肌力学参数 /
- 预后
Abstract:Objective Speckle tracking imaging (STI) stratified strain technique was used to detect the myocardial mechanics parameters of patients with myocardial infarction (MI), and its predictive value for the short-term prognosis after percutaneous coronary intervention (PCI) was explored. Methods From June 2022 to October 2023, 180 MI patients (MI group) and 40 healthy patients (control group) undergoing PCI in Sanmenxia Hospital of the Yellow River were selected. MI patients were divided into two groups according to short-term prognosis, and receiver operating characteristic (ROC) curves were analyzed to evaluate the predictive value of myocardial mechanical parameters on short-term prognosis after PCI. Results The left ventricular ejection fraction, the global medial, middle, and outer longitudinal strains of the left ventricle (GLS-endo, GLS-mid, GLS-epi), and the annulus inward, middle, and outer layers (GCS-endo, GCS-mid, GCS-epi) in the MI group were lower than those in the control group, and the left ventricular systolic volume and end-diastolic volume were higher than those in the control group (P < 0.05). The overall longitudinal strain of the left ventricle and the inward, middle, and outer strain of the left ventricle in the poor prognosis group were lower than those in the good prognosis group (P < 0.05). Logistic regression results showed that Killip grade Ⅲ, 6-12 h vascular opening was a risk factor for poor short-term prognosis, and high levels of GLS-endo and GCS-endo were protective factors (P < 0.05). ROC showed that the prediction efficiency of GLS-endo and GCS-endo combination was higher than that of the single detection (Z=2.019, P=0.044; Z=2.624, P=0.006). Conclusion GLS-endo and GCS-endo are the influencing factors of short-term prognosis after PCI in MI patients, and their combination has a high predictive value for poor short-term prognosis. -
图 1 心内膜分层(外层、中层、内层)纵向应变牛眼示意图
注：负向应变代表收缩期心肌缩短，负向应变越大，颜色标记越接近深红色，颜色越红，表示达峰时间越长。
Figure 1. Schematic diagram of longitudinal strain bovine eye in endocardial stratification (outer, middle, inner)
图 2 GLS-endo、GCS-endo单独及联合预测PCI术后短期预后的ROC曲线
Figure 2. ROC curves of GLS-endo and GCS-endo alone and in combination to predict short-term prognosis after PCI
表 1 对照组与MI组心肌力学参数水平比较(x±s)
Table 1. Comparison of myocardial mechanics parameters between the control group and the MI group (x±s)
组别 例数 LVEF(%) LVEDV(mL) LVESV(mL) GLS-endo GLS-mid GLS-epi GCS-endo GCS-mid GCS-epi 对照组 40 54.19±4.21 108.86±15.06 66.79±7.95 -22.95±1.25 -20.66±1.42 -18.10±1.34 -25.71±1.66 -20.83±1.82 -17.05±1.26 MI组 180 38.95±4.63 116.20±13.95 74.83±12.34 -15.19±3.14 -11.49±2.69 -10.21±2.86 -16.82±3.05 -12.95±2.89 -9.77±2.21 t值 19.112 3.148 3.939 15.340 20.897 17.015 17.835 16.515 20.097 P值 ＜0.001 0.002 ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001 
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表 2 预后良好组及预后不良组MI患者心肌力学参数水平比较(x±s)
Table 2. Comparison of myocardial mechanical parameters in MI patients with good and poor prognosis (x±s)
组别 例数 LVEF(%) LVEDV(mL) LVESV(mL) GLS-endo GLS-mid GLS-epi GCS-endo GCS-mid GCS-epi 预后良好组 133 39.96±4.59 114.76±19.72 73.96±13.27 -15.97±2.31 -12.06±2.73 -10.76±2.93 -17.83±3.19 -13.54±3.02 -10.23±2.38 预后不良组 47 38.59±4.72 120.29±20.33 77.31±11.91 -12.98±2.96 -9.88±2.59 -8.65±2.51 -13.96±2.81 -11.28±2.71 -8.47±2.24 t值 1.723 1.639 1.527 6.278 3.275 4.398 7.366 4.525 4.424 P值 0.087 0.103 0.129 ＜0.001 0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001
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表 3 预后良好组及预后不良组MI患者临床资料比较
Table 3. Comparison of clinical data of MI patients in the good and poor prognosis groups
项目 预后良好组(n=133) 预后不良组(n=47) 统计量 P值 性别[例(%)] 0.402a 0.526 男性 75(56.39) 29(61.70) 女性 58(43.61) 18(38.30) 年龄(x±s，岁) 55.86±6.15 54.29±6.47 1.484b 0.140 BMI(x±s) 23.05±1.06 23.21±1.13 0.874b 0.384 Killip分级[例(%)] 7.313a 0.007 Ⅰ~Ⅱ级 99(74.44) 25(53.19) Ⅲ级 34(25.56) 22(46.81) 吸烟史[例(%)] 41(30.83) 17(36.17) 0.454a 0.500 饮酒史[例(%)] 46(34.59) 19(40.43) 0.513a 0.474 脑卒中史[例(%)] 13(9.77) 8(17.02) 1.770a 0.183 合并症[例(%)] 糖尿病 29(21.80) 14(29.79) 1.217a 0.270 高血压 35(26.32) 17(36.17) 1.642a 0.200 高脂血症 35(26.32) 16(34.04) 1.021a 0.312 病变支数[例(%)] 4.003c ＜0.001 单只 65(48.87) 9(19.15) 双支 41(30.83) 16(34.04) 三支及以上 27(20.30) 22(46.81) 心肌梗死面积[例(%)] 2.218c 0.330 小面积梗死 43(32.33) 17(36.17) 中面积梗死 69(51.88) 19(40.43) 大面积梗死 21(15.79) 11(23.40) 开通罪犯血管的时间[例(%)] 9.653a 0.002 ＜6 h 98(73.68) 23(48.94) 6~12 h 35(26.32) 24(51.06) 合并术前用药[例(%)] 他汀类 106(79.70) 35(74.47) 0.560a 0.454 双抗 87(65.41) 29(61.70) 0.209a 0.648 替罗非班 119(89.47) 40(85.11) 0.643a 0.423 肌酸激酶(x±s，U/L) 1 416.65±306.96 1 495.6±335.45 1.479b 0.141 肌酸激酶同工酶(x±s，U/L) 288.87±40.33 296.79±39.56 1.163b 0.246 脑利尿钠肽(x±s，ng/L) 336.59±53.29 577.54±95.33 3.442b 0.001 靶血管长度(x±s，mm) 2.85±0.49 2.94±0.54 1.054b 0.294 靶血管直径(x±s，mm) 23.95±4.36 24.61±4.57 0.881b 0.380 植入支架数量(x±s，个) 1.65±0.24 1.82±0.21 2.698b 0.008 心率(x±s，次/min) 75.95±11.26 77.16±10.79 0.640b 0.523 收缩压(x±s，mmHg) 116.71±14.26 119.26±13.05 1.077b 0.283 舒张压(x±s，mmHg) 75.49±8.16 77.50±8.79 1.422b 0.157 白细胞计数(x±s，×109/L) 7.85±1.86 8.09±1.93 0.753b 0.452 血小板计数(x±s，×109/L) 219.26±41.55 228.54±49.31 1.252b 0.212 总胆固醇(x±s，mmol/L) 4.36±1.09 4.51±1.26 0.778b 0.438 三酰甘油(x±s，mmol/L) 3.89±1.15 3.94±1.07 0.261b 0.795 高密度脂蛋白胆固醇(x±s，mmol/L) 1.04±0.33 1.07±0.26 0.564b 0.573 低密度脂蛋白胆固醇(x±s，mmol/L) 2.79±0.87 2.93±0.75 0.981b 0.328 天门冬氨酸氨基转移酶(x±s，U/L) 116.24±38.59 121.73±33.45 0.867b 0.387 丙氨酸氨基转移酶(x±s，U/L) 50.49±17.26 53.21±15.76 0.948b 0.344 注：a为χ2值，b为t值, c为Z值。1 mmHg=0.133 kPa。
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表 4 MI患者PCI术后短期预后影响因素的多因素logistic回归分析
Table 4. Multivariate logistic regression analysis affecting the short-term prognosis of MI patients after PCI
变量 B SE Waldχ2 P值 OR值 95% CI Killip分级 0.227 0.095 5.710 ＜0.001 1.255 1.042~1.512 病变支数 0.605 0.325 3.465 0.091 1.831 0.969~3.463 开通罪犯血管的时间 0.596 0.245 5.918 ＜0.001 1.815 1.123~2.934 脑利尿钠肽 0.596 0.334 3.603 0.083 1.815 0.981~3.358 植入支架数量 0.841 0.483 3.032 0.154 2.319 0.900~5.976 GLS-endo -0.409 0.201 4.141 ＜0.001 0.664 0.448~0.985 GLS-mid -0.565 0.305 3.432 0.076 0.568 0.313~1.033 GLS-epi -0.395 0.221 3.195 0.095 0.674 0.437~1.039 GCS-endo -0.245 0.119 4.239 ＜0.001 0.783 0.620~0.988 GCS-mid -0.664 0.340 3.814 0.115 0.515 0.264~1.002 GCS-epi -0.492 0.254 3.752 0.073 0.611 0.372~1.006 注：变量赋值如下，Killip分级，Ⅲ级=1，Ⅰ~Ⅱ级=0；病变支数，三支及以上=2，双支=1，单支=0；开通罪犯血管的时间，6~12 h=1，＜6 h=0；其余连续变量均以实际值赋值。
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表 5 心肌力学参数对PCI术后短期预后的预测价值
Table 5. The predictive value of myocardial mechanical parameters for short-term prognosis after PCI
指标 截断值 灵敏度
(%)特异度
(%)AUC 95% CI 约登指数 GLS-endo 13.41 77.78 67.41 0.767 0.699~0.827 0.452 GCS-endo 14.73 60.00 83.70 0.714 0.642~0.779 0.437 联合 1.76a 91.11 84.44 0.870 0.812~0.915 0.756 注：a联合预测采用LogP模式进行拟合；联合诊断最佳截断值依据Log(P/1-P)模型生成。
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