三维斑点追踪技术预测心肌梗死患者经皮冠状动脉介入术后发生主要心脏不良事件的临床价值

目的：探究应用三维超声斑点追踪成像(3D-STI)评估心肌梗死(MI)患者左室心肌应变及预测介入术后主要心脏不良事件(MACEs)的临床价值。方法：选择2019年10月~2022年10月我院收治的105例行PCI术的MI患者作为研究对象,住院期间均依据指南推荐给予相应的药物和PCI介入治疗,出院前均进行3D-STI检查以评估患者心脏功能,出院后对其进行常规随访1年,以是否发生MACEs 进行分组,分为MACEs组(n=14)和无MACEs组(n=91),比较两组一般资料、心功能指标和心肌应变指标水平,采用Pearson相关性分析左室各心肌应变值与左室射血分数(LVEF)的关系,采用ROC曲线分析左室心肌应变指标预测介入术后MACEs的临床价值。结果：MACEs组和无MACEs组性别、疾病史、口服用药史及支架数目比较差异均无统计学意义(P>0.05),MACEs组年龄和靶血管直径狭窄率均明显高于无MACEs组；MACEs组LVEF、整体面积应变(GAS)、环向峰值应变(GCS)、纵向峰值应变(GLS)及径向峰值应变(GRS)值均明显低于无MACEs组；Pearson分析显示,各心肌应变指标值与LVEF 均呈正相关(P<0.05)；ROC分析显示,各心肌应变指标值对预测介入术后MACEs的发生均具有较高效能(P<0.05)。结论：应用3D-STI能准确评估MI患者左室心肌应变情况,且各心肌应变指标值对预测介入术后MACEs的发生均具有一定参考价值,可为临床早期识别MI患者不良预后提供更为全面的指导。

Clinical value of speckle tracking imaging on evaluating left ventricular myocardial strain and predicting MACEs after interventional therapy in patients with myocardial infarction

Objective: To explore the clinical value of three-dimensional ultrasound speckle tracking imaging (3D-STI) on evaluating the left ventricular myocardial strain and predicting the major adverse cardiac events (MACEs) after percutaneous coronary intervention (PCI) in patients with myocardial infarction (MI). Methods: Totally 105 patients with MI who underwent PCI in the hospital from October 2019 to October 2022 were selected as the research subjects. During hospitalization, the corresponding drugs and PCI therapy recommended by the guidelines were performed on patients. 3D-STI examination was performed to evaluate the cardiac function of patients before discharge, and the patients were routinely followed up for 1 year after discharge and were divided into MACEs group (n=14) and non-MACEs group (n=91) according to the presence or absence of MACEs. The general data, cardiac function indicators and myocardial strain indicators were compared between the two groups. Pearson correlation analysis was used to analyze the relationship between left ventricular myocardial strain indicators and LVEF. ROC curve was applied to analyze the clinical value of left ventricular myocardial strain indicators on predicting MACEs after interventional therapy. Results: There were no statistically significant differences in gender, disease history, history of oral medication and the number of stents between MACEs group and non-MACEs group (P>0.05). The age and target vessel diameter stenosis rate in MACEs group were significantly older or higher than those in non-MACEs group. The LVEF, global area strain (GAS), global circumferential peak strain (GCS), global longitudinal peak strain (GLS) and global radial peak strain (GRS) were significantly lower in MACEs group than those in non-MACEs group. Pearson analysis showed that the myocardial strain indicators were positively correlated with LVEF (P<0.05). ROC analysis revealed that the myocardial strain indicators had high efficiency on predicting the occurrence of MACEs after interventional therapy (P<0.05). Conclusion: The application of 3D-STI can accurately evaluate the left ventricular myocardial strain in patients with MI, and myocardial strain indicators have certain reference value om predicting the occurrence of MACEs after interventional therapy, and it can provide comprehensive guidance for early clinical identification of poor prognosis in patients with MI.