Wang Kai, Wang Lin, He Fei, Li Haoliang, Fang Yu, Hu Guangquan, Wang Xiaochen
Department of Cardiology, Second Affiliated Hospital of Anhui Medical University, China.
Heliyon. 2024 Jul 23;10(15):e35078. doi: 10.1016/j.heliyon.2024.e35078. eCollection 2024 Aug 15.
To assess the changes in QRS duration (△QRSd) before and after primary percutaneous coronary intervention(PPCI) regarding the relation of left ventricular ejection fraction (LVEF) in patients after a first acute ST segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI).
A total of 244 patients with STEMI were enrolled, and clinical, biochemical, and angiographic parameters were compared between two groups based on LVEF at 6 months post-discharge. QRS duration (QRSd) was analyzed in relation to LVEF, and feature selection using least absolute shrinkage and selection operator(LASSO) regression was performed. Logistic regression analysis and receiver operating characteristic (ROC) curve evaluation were conducted to identify predictors and assess model efficacy.
Significant differences were observed between the two groups in terms of various parameters, including age, time from symptom onset to balloon dilation (STB), N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, Left ventricular end-diastolic volume(LVEDV) at baseline, left ventricular end-systolic volume(LVESV)at baseline, left ventricular end-diastolic diameter (LVDD)at baseline and six months, hospital length of stay(days), ST-segment resolution (STR), the left anterior descending artery as the infarction-related artery (IRA-LAD), frequency of TIMI 3 flow post PPCI, thrombus aspiration and/or intracoronary thrombolysis, the use of tirofiban, and the number of implanted stents(stents).In addition, postoperative QRSd and △QRSd were significantly higher in patients with left ventricular systolic dysfunction(LVSD). LASSO regression selected six variables as predictors of postoperative LVEF. Logistic regression analysis identified age, STB, NT-proBNP, LVESV at baseline,△QRSd, and stents, as independent factors associated with LVSD within six months for patients with a first occurrence of STEMI. The models achieved AUC values of 0.906 (using ΔQRSd),0.922(using 6 variables excluding ΔQRSd) and 0.962 (using 6 variables).
This study identified ΔQRSd as a potential predictor of LVSD in patients with STEMI. The developed models showed good efficacy in predicting postoperative LVEF changes. These findings may contribute to risk stratification and individualized management strategies for STEMI patients.
评估首次急性ST段抬高型心肌梗死（STEMI）患者接受直接经皮冠状动脉介入治疗（PPCI）前后QRS波时限（△QRSd）的变化与左心室射血分数（LVEF）的关系。
共纳入244例STEMI患者，根据出院后6个月时的LVEF将两组患者的临床、生化和血管造影参数进行比较。分析QRS波时限（QRSd）与LVEF的关系，并使用最小绝对收缩和选择算子（LASSO）回归进行特征选择。进行逻辑回归分析和受试者工作特征（ROC）曲线评估，以识别预测因素并评估模型效能。
两组在年龄、症状发作至球囊扩张时间（STB）、N末端B型利钠肽原（NT-proBNP）水平、基线左心室舒张末期容积（LVEDV）、基线左心室收缩末期容积（LVESV）、基线及6个月时的左心室舒张末期直径（LVDD）、住院天数、ST段回落（STR）、梗死相关动脉为左前降支（IRA-LAD）、PPCI后TIMI 3级血流频率、血栓抽吸和/或冠状动脉内溶栓、替罗非班的使用以及植入支架数量（stents）等各项参数方面存在显著差异。此外，左心室收缩功能障碍（LVSD）患者术后QRSd和△QRSd显著更高。LASSO回归选择了6个变量作为术后LVEF的预测因素。逻辑回归分析确定年龄、STB、NT-proBNP、基线LVESV、△QRSd和支架为首次发生STEMI患者6个月内与LVSD相关的独立因素。模型的AUC值分别为0.906（使用△QRSd）、0.922（使用排除△QRSd的6个变量）和0.962（使用6个变量）。
本研究确定△QRSd为STEMI患者LVSD的潜在预测因素。所建立的模型在预测术后LVEF变化方面显示出良好的效能。这些发现可能有助于STEMI患者的风险分层和个体化管理策略。
