上海交通大学学报（医学版）

上海交通大学学报(医学版) ›› 2021, Vol. 41 ›› Issue (11): 1478-1484.doi: 10.3969/j.issn.1674-8115.2021.11.011

• 论著 · 临床研究 • 上一篇    下一篇

心肌应变对急性ST段抬高型心肌梗死后心室重构的预测价值探讨

高亚洁1(), 马文坤1, 高程洁2, 周翌1, 潘静薇1()   

  1. 1.上海交通大学附属第六人民医院心内科，上海 200233
    2.上海交通大学附属第六人民医院老年科，上海 200233
  • 出版日期:2021-11-28 发布日期:2021-12-03
  • 通讯作者: 潘静薇 E-mail:13333110348@163.com;jwpan@sjtu.edu.cn
  • 作者简介:高亚洁（1995—），女，硕士生；电子信箱：13333110348@163.com。
  • 基金资助:
    上海市2021年度“科技创新行动计划”医学创新研究专项(21Y11909400)

Exploration of the predictive value of myocardial strain on ventricular remodeling after acute ST-segment elevation myocardial infarction

Ya-jie GAO1(), Wen-kun MA1, Cheng-jie GAO2, Yi ZHOU1, Jing-wei PAN1()   

  1. 1.Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
    2.Department of Geriatrics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
  • Online:2021-11-28 Published:2021-12-03
  • Contact: Jing-wei PAN E-mail:13333110348@163.com;jwpan@sjtu.edu.cn
  • Supported by:
    Medical Innovation Research Special Project of 2021 "Science and Technology Innovation Action Plan" of Shanghai(21Y11909400)

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摘要：

目的·探讨急性ST段抬高型心肌梗死（ST-segment elevation myocardial infarction，STEMI）后心肌应变参数对左心室重构（left ventricular remodeling，LVR）的预测价值。方法·序贯纳入2018年12月至2019年12月就诊于上海交通大学附属第六人民医院心内科并成功接受急诊经皮冠状动脉介入治疗的STEMI患者47例。分别于STEMI急性期及1年后进行心脏磁共振检测，分析左心室每搏输出量（left ventricular stroke volume，LVSV）、左心室质量指数（left ventricular mass index，LVMI）、整体纵向应变（global longitudinal strain，GLS）、整体周向应变（global circumferential strain，GCS）、整体径向应变（global radial strain，GRS）等指标，采集STEMI急性期峰值超敏血清肌钙蛋白I（hypersensitive serum cardiac troponin I，hs-cTnI）、峰值脑钠肽前体（brain natriuretic peptide precursor，proBNP）等生化指标及年龄、性别、血压、心率（heart rate，HR）等临床数据。采取2种模型定义LVR：第1种为STEMI 1年后左心室舒张末期容积（left ventricular end diastolic volume，LVEDV）较基线增加≥20%；第2种为STEMI 1年后左心室收缩末期容积（left ventricular end systolic volume，LVESV）较基线增加≥15%。依据上述2种模型分别将STEMI患者分为LVR组及non-LVR组，比较2组患者之间心脏磁共振指标、生化指标及临床数据的差异，并进行Logistic回归分析，绘制受试者工作特征曲线（receiver operating characteristic curve，ROC曲线）。结果·在STEMI 1年后LVEDV较基线增加≥20%的模型中，LVR组与non-LVR组之间基线HR、LVSV、LVMI、GLS、GCS、GRS的差异均有统计学意义（P=0.003，P=0.034，P=0.029，P=0.003，P=0.016，P=0.019）；Logistic回归分析显示，基线HR和GLS均与LVR显著相关（β=-0.070，OR=0.932，P=0.043；β=-0.334，OR=0.716，P=0.031）；当GLS截断值为-9.835时，其预测LVR的敏感度为75.0%，特异度为71.0%。在STEMI 1年后LVESV较基线增加≥15%的模型中，LVR组与non-LVR组之间峰值hs-cTnI、峰值proBNP、LVMI、GLS差异均有统计学意义（P=0.035，P=0.044，P=0.034，P=0.010）；Logistic回归分析显示，峰值hs-cTnI和基线GLS均与LVR显著相关（β=-0.017，OR=0.982，P=0.024；β=-0.304，OR=0.738，P=0.041）；当GLS截断值为-11.145时，其预测LVR的敏感度为94.1%，特异度为50.0%。结论·心脏磁共振参数基线GLS对STEMI患者LVR有较好的预测价值，而GCS、GRS的预测价值不显著。

关键词: 急性ST段抬高型心肌梗死, 左心室重构, 心脏磁共振, 整体纵向应变, 整体周向应变, 整体径向应变

Abstract:

Objective·To investigate the predictive value of myocardial strain in left ventricular remodeling (LVR) after acute ST-segment elevation myocardial infarction (STEMI).

Methods·Forty-seven patients with STEMI who were admitted to Department of Cardiology of Shanghai Sixth People's Hospital, Shanghai Jiao Tong University from December 2018 to December 2019 and successfully received emergency primary percutaneous coronary intervention were included. Cardiac magnetic resonance (CMR) was performed at the acute stage of STEMI and 1 year later. Left ventricular stroke volume(LVSV), left ventricular mass index (LVMI), global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS) were analyzed. Biochemical indexes such as peak hypersensitive serum cardiac troponin I (hs-cTnI) and peak brain natriuretic peptide precursor (proBNP) and clinical data such as age, sex, blood pressure, heart rate (HR) were collected. LVR was defined as the following 2 models. The first one was that the left ventricular end diastolic volume (LVEDV) increased by ≥20% after 1 year of STEMI compared with the baseline. The second one was that the left ventricular end systolic volume (LVESV) increased by ≥15% after 1 year of STEMI compared with the baseline. Patients with STEMI were divided into LVR group and non-LVR group according to the above two models. The differences of CMR index, biochemical index and clinical data between the two groups were compared. Logistic regression was performed and receiver operating characteristic curve was drawn.

Results·In the model where LVEDV increased by ≥20% 1 year after the acute stage of STEMI, the LVR group and the non-LVR group had statistically significant differences in baseline HR (P=0.003), LVSV (P=0.034), LVMI (P=0.029), GLS (P=0.003), GCS (P=0.016) and GRS (P=0.019). Logistic regression analysis showed that baseline HR and GLS were significantly correlated with LVR (β=-0.070, OR=0.932, P=0.043; β=-0.334, OR=0.716, P=0.031). When the cut-off value of GLS was -9.835, the sensitivity and specificity of LVR prediction were 75.0% and 71.0%, respectively. In the model where LVESV increased by≥15% 1 year after the acute stage of STEMI, there were statistically significant differences in peak hs-cTnI (P=0.035), peak proBNP (P=0.044), LVMI (P=0.034) and GLS (P=0.010) between the LVR group and the non-LVR group. Logistic regression analysis showed that peak hs-cTnI and baseline GLS were significantly correlated with LVR (β=-0.017, OR=0.982, P=0.024; β=-0.304, OR=0.738, P=0.041). When the cut-off value of GLS was -11.145, the sensitivity and specificity for LVR prediction were 94.1% and 50.0%, respectively.

Conclusion·In patients with STEMI, baseline GLS has a good predictive value for LVR, while GCS and GRS have no significant predictive value.

Key words: acute ST-segment elevation myocardial infarction (STEMI), left ventricular remodeling, cardiac magnetic resonance (CMR), global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS)

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