超声造影定量参数对慢性冠脉综合征患者远期预后的影响
Effect of quantitative parameters of contrast-enhanced ultrasound on the long-term prognosis of patients with chronic coronary syndrome.
作者信息
Li Jia, Ma Chunyan, Sun Haixia, Li Fang, She Yao, Yi Tianhong
机构信息
Cardiovascular Ultrasound Room, Qinghai Provincial People's Hospital, Xining, China.
Department of Ultrasound, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, China.
出版信息
J Thorac Dis. 2023 Dec 30;15(12):6806-6812. doi: 10.21037/jtd-23-1267. Epub 2023 Dec 10.
BACKGROUND
Ultrasound is one of the most commonly used examination methods in patients with coronary artery disease (CAD) and is valuable in evaluating patient prognosis. Although contrast-enhanced ultrasound (CEUS) can assess more in depth the vascular lesions of patients, there is still a lack of relevant research on the value of quantitative parameters of CEUS in predicting the long-term prognosis of patients with chronic coronary syndrome (CCS), thus, we designed this study.
METHODS
From January 2016 to December 2017, a total of 473 patients with CCS admitted to Yueyang People's Hospital were retrospectively enrolled. The patients were followed up for five years. According to whether the patients had major adverse cardiovascular events (MACE), patients were divided into the MACE group (n=113) and the control group (n=360). The CEUS was performed to detect the myocardial perfusion status. The value of quantitative parameters of CEUS in predicting the MACE in patients with CCS was analyzed using the receiver operating characteristic (ROC) curve.
RESULTS
Peak intensity of contrast agent at platform stage, rising rate of microbubble reperfusion, and left ventricular ejection fraction (LVEF) were found to be valuable in predicting the risk of MACE in patients with CCS. Among them, the peak intensity of contrast agent at platform stage had the highest predictive value, and the area under the curve (AUC) was 0.860 [95% confidence interval (CI): 0.827-0.894, P<0.001]. Multivariate logistics regression analysis showed that the peak intensity of contrast agent at platform stage <4.54 dB and rising rate of microbubble reperfusion <0.275 s were independent risk factors of MACE in patients with CCS. The relative risks were 12.238 (95% CI: 6.632-22.585) and 5.724 (95% CI: 3.149-10.405), respectively.
CONCLUSIONS
Quantitative parameters of CEUS can be used as predictors of MACE in patients with CCS, and strengthening the management of such high-risk patients may be beneficial to reduce the incidence of MACE.
背景
超声是冠心病(CAD)患者最常用的检查方法之一,对评估患者预后具有重要价值。尽管超声造影(CEUS)能更深入地评估患者的血管病变,但关于CEUS定量参数在预测慢性冠状动脉综合征(CCS)患者长期预后方面的价值仍缺乏相关研究,因此,我们设计了本研究。
方法
回顾性纳入2016年1月至2017年12月在岳阳市人民医院住院的473例CCS患者。对患者进行了为期五年的随访。根据患者是否发生主要不良心血管事件(MACE),将患者分为MACE组(n = 113)和对照组(n = 360)。进行CEUS检测心肌灌注状态。采用受试者工作特征(ROC)曲线分析CEUS定量参数对CCS患者发生MACE的预测价值。
结果
发现平台期造影剂峰值强度、微泡再灌注上升速率和左心室射血分数(LVEF)对预测CCS患者发生MACE的风险具有重要价值。其中,平台期造影剂峰值强度的预测价值最高,曲线下面积(AUC)为0.860 [95%置信区间(CI):0.827 - 0.894,P < 0.001]。多因素logistic回归分析显示,平台期造影剂峰值强度<4.54 dB和微泡再灌注上升速率<0.275 s是CCS患者发生MACE的独立危险因素。相对风险分别为12.238(95% CI:6.632 - 22.585)和5.724(95% CI:3.149 - 10.405)。
结论
CEUS定量参数可作为CCS患者发生MACE的预测指标,加强对此类高危患者的管理可能有助于降低MACE的发生率。