负荷超声心动图联合心肌声学造影评估缺血性心脏病患者临床预后的价值

目的探讨负荷超声心动图联合心肌声学造影评估疑诊或确诊冠心病患者发生不良心血管事件的价值。 方法回顾性连续纳入南方医科大学南方医院心内科2014年2月至2020年9月进行负荷超声心动图联合心肌声学造影的疑诊或确诊冠心病患者共361例。根据负荷超声心动图结果将患者分为正常组（260例）和异常组（101例）。随访不良心血管终点事件（主要终点事件包括全因性死亡、心血管死亡和非致死性心肌梗死，次要终点事件包括心绞痛住院、血运重建），比较负荷超声异常组与负荷超声正常组不良事件发生率；应用Cox回归分析及KM生存曲线分析终点事件发生的预测因素及2年、5年无主要心血管不良事件生存率。 结果361例患者完成随访，平均随访时间（41.05±22.50）个月。7例患者出现主要终点事件，39例患者发生心绞痛住院事件，55例患者进行了血运重建。其中，负荷超声正常组2例发生主要终点事件，36例发生次要终点事件，负荷超声异常组5例发生主要终点事件，41例发生次要终点事件，负荷超声异常组与正常组不良事件发生率差异有统计学意义（P＜0.001）。Cox比例风险模型多因素分析结果显示，负荷超声心动图结果（HR=0.354，95%CI：0.221~0.569，P＜0.001）是终点事件的预测因素之一。KM生存曲线分析提示负荷超声正常组2年、5年无主要心血管不良事件生存率分别为96.2%、84.9%，而负荷超声异常组2年、5年无主要心血管不良事件生存率分别为93.8%、66.2%，2组患者的生存率曲线差异有统计学意义（P＜0.001）。 结论负荷超声心动图检查在诊断冠状动脉疾病、风险分层和血运重建指导方面发挥着重要作用，可作为冠心病或疑诊冠心病患者预后评估的重要手段。

Value of stress echocardiography combined with myocardial contrast echocardiography in evaluating prognosis of patients with ischemic heart disease

ObjectiveTo assess the value of stress echocardiography combined with myocardial contrast echocardiography in evaluating adverse cardiovascular events in patients with suspected or diagnosed coronary heart disease. MethodsA total of 361 patients with suspected or confirmed coronary heart disease who underwent stress echocardiography combined with myocardial contrast echocardiography from February 2014 to September 2020 at the Department of Cardiology, Nanfang Hospital, Southern Medical University were retrospectively included. According to the results of stress echocardiography, the patients were divided into either a normal group (260 cases) or an abnormal group (101 cases). Adverse cardiovascular endpoints (the primary endpoints included all-cause death, cardiovascular death, and nonfatal myocardial infarction, and the secondary endpoints included hospitalization for angina pectoris and revascularization) were followed, and the incidence of adverse events was compared between the abnormal group and normal group. Cox regression analysis and Kaplan-Meier survival analysis were used performed to indentify the predictors of endpoint events and calculate the 2-year and 5-year survival rates without major cardiovascular adverse events, respectively. ResultsThe 361 patients were followed up for an average of (41.05±22.50) months. The primary endpoint event occurred in 7 patients, hospitalization for angina pectoris occurred in 39, and revascularization was performed in 55. Two patients in the normal group had a primary endpoint event, and 36 had a secondary endpoint event; 5 patients in the abnormal group had a primary endpoint event, and 41 patients had a secondary endpoint event. There was a statistically significant difference in the incidence of adverse events between the two groups (P＜0.001). Multivariate analysis using a Cox proportional hazard model showed that stress echocardiography (hazard ratio=0.354, 95% confidence interval: 0.221~0.569, P＜0.001) was one of the predictors of the endpoints. Kaplan-Meier survival analysis showed that the 2-year and 5-year survival rates without major adverse cardiovascular events were 96.2% and 84.9% in the normal group, and 93.8% and 66.2% in the abnormal group, respectively. The difference in survival curves between the two groups was statistically significant (P＜0.001). ConclusionStress echocardiography plays an important role in the diagnosis of coronary artery disease, risk stratification, and guidance of revascularization, and can be used as an important means for prognosis evaluation of patients with suspected or confirmed coronary heart disease.