心肌声学造影超声心动图对STEMI患者PCI术后并发心力衰竭的预测价值

Predictive value of myocardial contrast echocardiography for heart failure after PCI in STEMI patients

摘要:

目的 研究心肌声学造影超声心动图（MCE）对ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入术（PCI）后并发心力衰竭（HF）的预测价值。方法 选取2019年12月至2022年12月周口市中心医院收治的STEMI患者140例，均行PCI术，根据术后30 d是否发生HF将其分为HF组（36例）、无HF组（92例）。比较两组一般资料及MCE定量参数A值、κ值、A×κ值；采用Logistic回归模型分析STEMI患者PCI术后并发HF的影响因素；绘制受试者工作特征曲线（ROC）曲线分析A值、κ值、A×κ值单独及联合预测STEMI患者PCI术后并发HF的效能。结果 与无HF组比较，HF组年龄较大，糖尿病史百分率及冠脉Gensini积分、血清肌酸激酶同工酶（CK-MB）水平较高，发病至梗死血管开通时间较长，A值、κ值、A×κ值均较低（P<0.05）；Logistic回归模型显示，年龄、冠脉Gensini积分、发病至梗死血管开通时间、A值、κ值、A×κ值是STEMI患者PCI术后并发HF的影响因素（P<0.05）；ROC曲线显示，与A值、κ值、A×κ值单独检验比较，三者联合检验的灵敏度升高（χ2=4.600，P=0.032；χ2=6.821，P=0.009；χ2=8.036，P=0.005）；A值、κ值、A×κ值预测STEMI患者PCI术后并发HF的曲线下面积（AUC）分别为0.834（95%CI：0.758~0.894）、0.773（95%CI：0.691~0.842）、0.802（95%CI：0.722~0.867），三者联合的AUC为0.908（95%CI：0.844~0.952）；Pairwise算法检验显示，与A值、κ值、A×κ值单独检验比较，三者联合检验的AUC升高（Z=2.295，P=0.022；Z=3.468，P=0.001；Z=2.774，P=0.006）。结论 MCE定量参数对STEMI患者PCI术后并发HF具有较高的预测价值。

Abstract:

Objective To study the predictive value of myocardial contrast echocardiography (MCE) for heart failure (HF) after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).Methods A total of 140 STEMI patients admitted to Zhoukou Central Hospital from December 2019 to December 2022 were selected, all of whom underwent PCI, and were divided into HF group (36 cases) and non-HF group (92 cases) according to whether HF occurred within 30 d after surgery. The general data and MCE quantitative parameters A value, κ value, A×κ value of the two groups were compared. Logistic regression model was used to analyze the influencing factors of HF after PCI in STEMI patients. Receiver operating characteristic (ROC) curve was drawn to analyze the efficacy of A value, κ value, A×κ value alone and combined in predicting HF after PCI in STEMI patients.Results Compared with non-HF group, the age in HF group was older (P<0.05), the percentage of diabetes history, coronary Gensini score and serum creatine kinase-MB (CK-MB) level were higher (P<0.05), the time from onset to infarction vessel opening was longer (P<0.05), and the A, κ and A× κ were lower (P<0.05). Logistic regression model showed that age, coronary Gensini score, opening time from onset to infarction vessel, A, κ and A× κ were the influencing factors of HF after PCI in STEMI patients (P<0.05). ROC curve showed that, compared with the separate test of A value, κ value and A×κ value, the sensitivity of the combined test was increased (χ²=4.600, P=0.032, χ²=6.821, P=0.009, χ²=8.036, P=0.005), the AUCs of A value, κ value and A×κ value in predicting HF after PCI in STEMI patients were 0.834 (95% CI: 0.758–0.894), 0.773 (95% CI: 0.691–0.842) and 0.802 (95% CI: 0.722–0.867), respectively, and the AUC of the combination of the three was 0.908 (95% CI: 0.844–0.952). Pairwise algorithm test showed that compared with A value, κ value and A×κ value alone, the AUC of the combination of the three increased (Z=2.295, P=0.022, Z=3.468, P=0.001, Z=2.774, P=0.006).Conclusion MCE quantitative parameters have a high predictive value for HF after PCI in STEMI patients.