一项关于通过新型四维超声心动图整体面积应变预测接受直接经皮冠状动脉介入治疗的ST段抬高型心肌梗死患者未来心血管事件的初步研究。
A Pilot Study to Predict Future Cardiovascular Events by Novel Four-dimensional Echocardiography Global Area Strain in ST-Elevation Myocardial Infarction Patients Managed by Primary Percutaneous Coronary Intervention.
作者信息
Ali Yasmin Abdelrazek, Alashry Ahmed Mohammed, Saad Maged Tawfik, Adel Walaa, El Fiky Azza Abdallah
机构信息
Department of Cardiology, Ain Shams University, Cairo, Egypt.
Department of Cardiology, Helwan University, Helwan, Egypt.
出版信息
J Cardiovasc Echogr. 2020 Apr-Jun;30(2):82-87. doi: 10.4103/jcecho.jcecho_68_19. Epub 2020 Aug 17.
CONTEXT
Four-dimensional speckle-tracking echocardiography (4D-STE) is ideal to accurately assess myocardial deformation. The novel 4D global area strain (GAS) uses global longitudinal and global circumferential strains (GCSs) to detect subtle changes in myocardium.
AIMS
The aim of this study was to determine the predictive value of 4D strain echocardiography for major adverse cardiovascular events (MACEs) in ST-elevation acute myocardial infarction (STEMI) patients after successful reperfusion by primary percutaneous coronary intervention (PCI).
SETTINGS AND DESIGN
This was a longitudinal study at a single center.
PATIENTS AND METHODS
We enrolled 170 patients who underwent successful primary PCI. Each patient was evaluated with 2D echocardiography and 4D echocardiography with 4D strain parameters and followed up over a year for the occurrence of MACE.
STATISTICAL ANALYSIS USED
Chi-square test, independent -tests, and multivariate logistic regression analysis were used.
RESULTS
Over 1 year of follow-up, 32 MACE were recorded. Patients with MACE were more likely to have had percutaneous transluminal coronary angioplasty done during the index primary PCI intervention, multivessel coronary artery disease, higher left ventricular end-diastolic and end-systolic dimensions (left ventricle end diastolic dimension (LVEDD) and left ventricle end systolic dimension (LVESD), respectively), lower 2D left ventricular ejection fraction (LVEF), higher wall motion score index, higher baseline heart rate, higher end-diastolic and end-systolic volumes, lower 3D-LVEF, higher 4D global longitudinal strain, 4D-GCS, 4D-GAS, and lower 4D global radial strain (4D-GRS) ( < 0.005 for all parameters). The most powerful predictor for MACE among our study population is 4D-GAS, with the best cutoff value of 4D-GAS >-17 ( = 0.008; odds ratio = 20.668; confidence interval = 2.227-191.827).
CONCLUSIONS
The novel 4D-GAS echocardiography predicts adverse clinical events in STEMI patients managed by successful primary PCI.
背景
四维斑点追踪超声心动图（4D-STE）是准确评估心肌变形的理想方法。新型的4D整体面积应变（GAS）利用整体纵向应变和整体圆周应变（GCS）来检测心肌的细微变化。
目的
本研究旨在确定4D应变超声心动图对经皮冠状动脉介入治疗（PCI）成功再灌注后的ST段抬高型急性心肌梗死（STEMI）患者主要不良心血管事件（MACE）的预测价值。
设置与设计
这是一项在单一中心进行的纵向研究。
患者与方法
我们纳入了170例行成功的直接PCI的患者。对每位患者进行二维超声心动图和具有4D应变参数的4D超声心动图评估，并随访一年观察MACE的发生情况。
所用统计分析方法
采用卡方检验、独立样本t检验和多因素逻辑回归分析。
结果
在1年的随访期间，记录到32例MACE。发生MACE的患者在首次直接PCI干预期间更有可能接受过经皮腔内冠状动脉成形术，患有多支冠状动脉疾病，左心室舒张末期和收缩末期尺寸更大（分别为左心室舒张末期内径（LVEDD）和左心室收缩末期内径（LVESD）），二维左心室射血分数（LVEF）更低，壁运动评分指数更高，基线心率更高，舒张末期和收缩末期容积更大，三维LVEF更低，4D整体纵向应变、4D-GCS、4D-GAS更高，4D整体径向应变（4D-GRS）更低（所有参数P<0.005）。在我们的研究人群中，MACE最有力的预测指标是4D-GAS，4D-GAS的最佳截断值> -17（P = 0.008；比值比= 20.668；置信区间= 2.227 - 191.827）。
结论
新型4D-GAS超声心动图可预测成功接受直接PCI治疗的STEMI患者的不良临床事件。
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