三维超声参数预测急性心肌梗死合并左心室室壁瘤经皮冠状动脉介入术后转归的价值

Value of three-dimensional ultrasound parameters in predicting the outcome of patients with acute myocardial infarction complicated with left ventricular aneurysm after PCI

摘要:

目的 探讨实时三维超声心动图（RT-3DE）对急性心肌梗死（AMI）合并左心室室壁瘤（LVA）患者经皮冠状动脉介入（PCI）术后转归的预测价值。方法 选取2018年1月—2020年1月在常州市第二人民医院行急诊PCI的80例AMI合并LVA患者。根据LVA病理解剖分型将患者分为A组（AMI合并功能性LVA）、B组（AMI合并解剖性LVA）和C组（AMI合并血栓性LVA），分别为31例、28例和21例。采用RT-3DE检测患者术前及术后2个月左心室心功能参数，包括左心室射血分数（LVEF）、左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）、心排血量（CO）、球形指数（SPI），并按照体表面积（BSA）计算左心室舒张末期容积指数（LVEDVI）、左心室收缩末期容积指数（LVESVI）及心脏指数（CI）。比较各组术前及术后2个月上述各参数的变化，分析术前及术后2个月LVEF、SPI与心功能指标的相关性。结果 C组患者手术前后LVEDV、LVESV、LVEDVI、LVESVI降低幅度小于A、B组（P <0.05）；C组患者手术前后CO、CI升高幅度大于A组，但小于B组（P <0.05）；B组患者手术前后LVEDV降低幅度小于A组（P <0.05），CO、CI升高幅度大于A组（P <0.05），LVESVI降低幅度大于A组（P <0.05）。C组患者手术前后LVEF升高幅度小于A、B组（P <0.05），SPI降低幅度小于A组（P <0.05）；B组患者手术前后SPI降低幅度小于A组（P <0.05）。AMI合并LVA患者手术前LVEF与LVEDV、LVESV、CO、LVEDVI、LVESVI、CI呈负相关（r =-0.614、-0.736、-0.364、-0.614、-0.739和-0.348，均P <0.05）；手术后LVEF与LVEDV、LVESV、CO、LVEDVI、LVESVI、CI呈负相关（r =-0.605、-0.720、-0.335、-0.594、-0.725和-0.320，均P <0.05）。手术前后SPI与LVEDV、LVESV、CO、LVEDVI、LVESVI、CI无相关性（P >0.05）。结论 急诊PCI术后2个月AMI合并功能性及解剖性LVA患者心室形态和整体收缩功能均明显改善，手术效果确切，RT-3DE可评估急诊PCI的短期疗效。

Abstract:

Objective To investigate the predictive value of real-time three-dimensional echocardiography (RT-3DE) parameters for the outcome of patients with acute myocardial infarction (AMI) complicated with left ventricular aneurysm (LVA) after percutaneous coronary intervention (PCI).Methods Eighty patients with AMI complicated with LVA who underwent emergency PCI in our hospital from January 2018 to January 2020 were collected. According to the pathoanatomical classification of LVA, these patients were divided into group A (AMI with functional LVA, n = 31), group B (AMI with anatomical LVA, n = 28) and group C (AMI with thrombosed LVA, n = 21). The left ventricular function parameters, including left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), cardiac output (CO), and spherical index (SPI), were measured via RT-3DE before and 2 months after the operation. Besides, left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI) and cardiac index (CI) were calculated according to the body surface area (BSA). The changes of these parameters before and 2 months after surgery in the three groups were compared, and the relationship between LVEF and SPI and other cardiac function parameters before and 2 months after the operation was analyzed.Results The decreases of LVEDV, LVESV, LVEDVI and LVESVI before and after the operation in group C were smaller than those in group A and B (P < 0.05). Compared with the group C, the increases of CO and CI before and after the operation were greater than those in group A but smaller than those in group B (P < 0.05). In group B, the decrease of LVEDV before and after the operation was smaller (P < 0.05), the increases of CO and CI were greater (P < 0.05), and the decrease of LVESVI was greater compared with group A (P < 0.05). As for group C, the increases of CO and CI before and after the operation were greater relative to those in group A yet smaller relative to those in group B (P < 0.05). In group B, the decrease of LVEDV before and after the operation was smaller (P < 0.05), the increases of CO and CI were greater (P < 0.05), and the decrease of LVESVI was greater compared with group A (P < 0.05). The increase of LVEF before and after the operation in the group C were smaller than that in the group A and B (P < 0.05), while the decrease of SPI before and after the operation in the group C was smaller than that in the group A (P < 0.05). In addition, the decrease of SPI before and after the operation in the group B was smaller than that in the group A (P < 0.05). Preoperative LVEF was negatively correlated with LVEDV, LVESV, CO, LVEDVI, LVESVI and CI in AMI patients with LVA (r = -0.614, -0.736, -0.364, -0.614, -0.739 and -0.348, all P <0.05). Postoperative LVEF was also negatively correlated with LVEDV, LVESV, CO, LVEDVI, LVESVI and CI (r = -0.605, -0.720, -0.335, -0.594, -0.725 and -0.320, all P <0.05). Neither preoperative SPI nor postoperative SPI was correlated with LVEDV, LVESV, CO, LVEDVI, LVESVI and CI (P > 0.05).Conclusions Two months after emergency PCI, the ventricular morphology and overall systolic function of AMI patients complicated with functional and anatomical LVA are significantly improved and the operation is effective, indicating that RT-3DE can evaluate the short-term efficacy of emergency PCI.