预测急性ST段抬高型心肌梗死后慢性心力衰竭的多变量模型：初步研究
A Multivariate Model to Predict Chronic Heart Failure after Acute ST-Segment Elevation Myocardial Infarction: Preliminary Study.
作者信息
Oleynikov Valentin Elievich, Averyanova Elena Vladimirovna, Oreshkina Anastasia Aleksandrovna, Burko Nadezhda Valerievna, Barmenkova Yulia Andreevna, Golubeva Alena Vladimirovna, Galimskaya Vera Aleksandrovna
机构信息
Department of Therapy, Medical Institute, Penza State University, 440026 Penza, Russia.
出版信息
Diagnostics (Basel). 2021 Oct 18;11(10):1925. doi: 10.3390/diagnostics11101925.
UNLABELLED
A multivariate model for predicting the risk of decompensated chronic heart failure (CHF) within 48 weeks after ST-segment elevation myocardial infarction (STEMI) has been developed and tested.
METHODS
The study included 173 patients with acute STEMI aged 51.4 (95% confidence interval (CI): 42-61) years. Two-dimensional (2D) speckle-tracking echocardiography (STE) has been performed on the 7th-9th days, and at the 12th, 24th, and 48th weeks after the index event with the analysis of volumetric parameters and values for global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS). A 24-h ECG monitoring (24 h ECG) of the electrocardiogram (ECG) to assess heart rate turbulence (HRT) has been performed on the 7th-9th days of STEMI. The study involved two stages of implementation. At the first stage, a multivariate model to assess the risk of CHF progression within 48 weeks after STEMI has been built on the basis of examination and follow-up data for 113 patients (group M). At the second stage, the performance of the model has been assessed based on a 48-week follow-up of 60 patients (group T).
RESULTS
A multivariate regression model for CHF progression in STEMI patients has been created based on the results of the first stage. It included the following parameters: HRT, left ventricular (LV) end-systolic dimension (ESD), and GLS. The contribution of each factor for the relative risk (RR) of decompensated CHF has been found: 3.92 (95% CI: 1.66-9.25) ( = 0.0018) for HRT; 1.04 (95% CI: 1.015-1.07) ( = 0.0027) for ESD; 0.9 (95% CI: 0.815-0.98) ( = 0.028) for GLS. The diagnostic efficiency of the proposed model has been evaluated at the second stage. It appeared to have a high specificity of 83.3%, a sensitivity of 95.8%, and a diagnostic accuracy of 93.3%.
CONCLUSION
The developed model for predicting CHF progression within 48 weeks after STEMI has a high diagnostic efficiency and can be used in early stages of myocardial infarction to stratify the risk of patients.
未标注
已开发并测试了一种用于预测ST段抬高型心肌梗死（STEMI）后48周内失代偿性慢性心力衰竭（CHF）风险的多变量模型。
方法
该研究纳入了173例急性STEMI患者，年龄为51.4岁（95%置信区间（CI）：42 - 61岁）。在第7 - 9天以及指数事件后的第12周、24周和48周进行了二维（2D）斑点追踪超声心动图（STE）检查，分析容积参数以及整体纵向应变（GLS）、整体圆周应变（GCS）和整体径向应变（GRS）值。在STEMI的第7 - 9天进行了24小时心电图（ECG）监测以评估心率震荡（HRT）。该研究涉及两个实施阶段。在第一阶段，基于对113例患者（M组）的检查和随访数据建立了一个多变量模型，以评估STEMI后48周内CHF进展的风险。在第二阶段，基于对60例患者（T组）的48周随访评估了该模型的性能。
结果
基于第一阶段的结果创建了一个用于STEMI患者CHF进展的多变量回归模型。它包括以下参数：HRT、左心室（LV）收缩末期内径（ESD）和GLS。已发现每个因素对失代偿性CHF相对风险（RR）的贡献：HRT为3.92（95%CI：1.66 - 9.25）（P = 0.0018）；ESD为1.04（95%CI：1.015 - 1.07）（P = 0.0027）；GLS为0.9（95%CI：0.815 - 0.98）（P = 0.028）。在第二阶段评估了所提出模型的诊断效率。其特异性为83.3%，敏感性为95.8%，诊断准确性为93.3%。
结论
所开发的用于预测STEMI后48周内CHF进展的模型具有较高的诊断效率，可用于心肌梗死早期对患者进行风险分层。
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