Cardiology Department, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, RS, 90035-003, Brazil.
Instituto de Cardiologia de Santa Catarina, São José, Brazil.
Intern Emerg Med. 2024 Nov;19(8):2167-2176. doi: 10.1007/s11739-024-03719-z. Epub 2024 Jul 24.
Development of ventricular failure and pulmonary edema is associated with a worse prognosis in ST-elevation myocardial infarction (STEMI). We aimed to evaluate the prognostic ability of a novel classification combining lung ultrasound (LUS) and left ventricular outflow tract (LVOT) velocity time integral (VTI) in patients with STEMI. LUS and LVOT-VTI were performed within 24 h of admission in STEMI patients. A LUS combined with LVOT-VTI (LUV) classification was developed based on LUS with < or ≥ 3 positive zone scans, combined with LVOT-VTI > or ≤ 14. Patients were classified as A (< 3zones/ > 14 cm VTI), B (≥ 3zones/ > 14 cm VTI), C (< 3zones/ ≤ 14 cm VTI) and D (≥ 3zones/ ≤ 14 cm VTI). Primary outcome was occurrence of in-hospital mortality. Development of cardiogenic shock (CS) within 24 h was also assessed. A total of 308 patients were included. Overall in-hospital mortality was 8.8%, while mortality for LUV A, B, C, and D was 0%, 3%, 12%, and 45%, respectively. The area under the curve (AUC) for predicting in-hospital mortality was 0.915. Moreover, after exclusion of patients admitted in Killip IV, at each increasing degree of LUV, a higher proportion of patients developed CS within 24 h: LUV A = 0.0%, LUV B 5%, LUV C = 12.5% and LUV D = 30.8% (p < 0.0001). The AUC for predicting CS was 0.908 (p < 0.001). In a cohort of STEMI patients, LUV provided to be an excellent method for prediction of in-hospital mortality and development of CS. LUV classification is a fast, non-invasive and very user-friendly ultrasonographic evaluation method to stratify the risk of mortality and CS.
在 ST 段抬高型心肌梗死（STEMI）患者中，心室衰竭和肺水肿的发展与预后较差相关。我们旨在评估一种新的分类方法，该方法结合了肺部超声（LUS）和左心室流出道（LVOT）速度时间积分（VTI）在 STEMI 患者中的预后能力。在 STEMI 患者入院后 24 小时内进行 LUS 和 LVOT-VTI 检查。根据 LUS 中 < 或 ≥ 3 个阳性区域扫描，并结合 LVOT-VTI > 或 ≤ 14，制定了 LUS 与 LVOT-VTI（LUV）联合分类。将患者分为 A（< 3 个区域/ > 14 cm VTI）、B（≥ 3 个区域/ > 14 cm VTI）、C（< 3 个区域/ ≤ 14 cm VTI）和 D（≥ 3 个区域/ ≤ 14 cm VTI）。主要结局是住院期间死亡率。还评估了 24 小时内心源性休克（CS）的发生情况。共纳入 308 例患者。总住院死亡率为 8.8%，而 LUV A、B、C 和 D 的死亡率分别为 0%、3%、12%和 45%。预测住院死亡率的曲线下面积（AUC）为 0.915。此外，排除 Killip IV 级入院患者后，随着 LUV 程度的增加，在 24 小时内发生 CS 的患者比例更高：LUV A = 0.0%、LUV B 为 5%、LUV C = 12.5%和 LUV D = 30.8%（p < 0.0001）。预测 CS 的 AUC 为 0.908（p < 0.001）。在 STEMI 患者队列中，LUV 是预测住院死亡率和 CS 发展的极好方法。LUV 分类是一种快速、非侵入性且非常易于使用的超声评估方法，可对死亡率和 CS 的风险进行分层。
