黎银春, 闫怡, 黄永. 心脏彩超参数联合血清NT-proBNP预测AMI患者PCI术后并发心力衰竭的价值分析[J]. 心脏杂志, 2022, 34(4): 428-434, 443. DOI: 10.12125/j.chj.202107067
    引用本文: 黎银春, 闫怡, 黄永. 心脏彩超参数联合血清NT-proBNP预测AMI患者PCI术后并发心力衰竭的价值分析[J]. 心脏杂志, 2022, 34(4): 428-434, 443. DOI: 10.12125/j.chj.202107067
    Yin-chun LI, Yi YAN, Yong HUANG. Value of cardiac color Doppler ultrasound parameters combined with serum NT proBNP in predicting heart failure after PCI in AMI patients[J]. Chinese Heart Journal, 2022, 34(4): 428-434, 443. DOI: 10.12125/j.chj.202107067
    Citation: Yin-chun LI, Yi YAN, Yong HUANG. Value of cardiac color Doppler ultrasound parameters combined with serum NT proBNP in predicting heart failure after PCI in AMI patients[J]. Chinese Heart Journal, 2022, 34(4): 428-434, 443. DOI: 10.12125/j.chj.202107067

    心脏彩超参数联合血清NT-proBNP预测AMI患者PCI术后并发心力衰竭的价值分析

    Value of cardiac color Doppler ultrasound parameters combined with serum NT proBNP in predicting heart failure after PCI in AMI patients

    • 摘要:
        目的  探讨心脏彩超参数联合血清N−端脑利钠肽前体(NT-proBNP)预测急性心肌梗死(AMI)患者经皮冠状动脉介入(PCI)治疗后并发心力衰竭的价值。
        方法  选取2018年3月~2020年1月重庆市江津区中心医院收治的行急诊PCI术治疗的169例AMI患者为研究组,另选取同期体检健康者144例为对照组,均行心脏彩超检查及血清NT-proBNP水平测定。术后随访6个月,根据心力衰竭并发情况将研究组患者分为并发心衰组与未并发心衰组,采用多因素Logistic回归性分析法分析术后24 h内的心脏彩超参数、血清NT-proBNP水平与AMI患者PCI术后并发心力衰竭的关系,采用受试者工作特征(ROC)曲线分析术后24 h内心脏彩超参数联合血清NT-proBNP水平对AMI患者PCI术后并发心力衰竭的预测价值。
        结果  研究组左室舒张末内径(LVEDD)、左室收缩末期内径(LVESD)、Tei指数均明显大于对照组(P<0.01),左室射血分数(LVEF)、二尖瓣舒张早期血流峰值速度(E峰)与舒张晚期血流峰值速度(A峰)比值(E/A)均明显小于对照组(P<0.01),血清NT-proBNP水平明显高于对照组(P<0.01);随访6个月,研究组患者心力衰竭并发率为18.34%(31/169);并发组(n = 31)与未并发组(n = 138)比较,年龄≥60岁(P<0.05)、多个梗死部位(P<0.01)、高血压(P<0.01)、糖尿病(P<0.05)、高脂血症(P<0.05)、PCI术后慢/无复流的占比均高于未并发组(P<0.01),发病至入院时间长于未并发组(P<0.01),冠脉病变支数、LVEDD、LVESD、Tei指数均大于未并发组(P<0.01),LVEF、E/A均小于未并发组(P<0.01),冠脉病变Gensini评分、cTnT、CK-MB、SBP、DBP、NT-proBNP水平高于未并发组(P<0.01),以上指标均是AMI患者PCI术后6个月并发心力衰竭的影响因素;经ROC曲线分析,PCI术后24 h内LVEDD、LVESD、LVEF、E/A、Tei指数单项及联合预测AMI患者PCI术后并发心力衰竭的灵敏度分别为83.87%、80.65%、80.65%、80.65%、83.87%、80.65%,特异度分别为75.36%、76.09%、78.26%、76.81%、76.09%、94.20%;PCI术后24 h内血清NT-proBNP水平及其与整体心脏彩超参数二者联合预测AMI患者PCI术后并发心力衰竭的灵敏度分别为83.87%和96.77%,特异度分别为91.30%和91.30%。
        结论  AMI患者PCI术后24 h内心脏彩超参数LVEDD、LVESD、Tei指数增大而LVEF、E/A减少,且血清NT-proBNP水平异常升高,以上各指标均对AMI患者PCI术后心力衰竭的发生具有一定的影响作用,并对并发心力衰竭具有一定的预测价值,但以整体心脏彩超参数与血清NT-proBNP水平联合预测时的价值更具临床意义,另患者年龄、发病至入院时间、冠脉病变支数、冠脉病变Gensini评分、cTnT、CK-MB、血压、梗死部位、高血压、糖尿病、高脂血症、PCI术后复流情况亦是AMI患者PCI术后并发心力衰竭的危险因素。

       

      Abstract:
        AIM  To investigate the predictive value of cardiac color Doppler ultrasound parameters combined with serum N-terminal pro-B-type natriuretic peptide (NT−proBNP) in predicting heart failure after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).
        METHODS  One hundred and sixty-nine AMI patients treated by emergency PCI admitted to our hospital from March 2018 to January 2020 were selected as the study group and 144 healthy people in the same period were selected as the control group, in whom color Doppler echocardiography was performed and serum NT-proBNP levels were detected. The patients in the study group were followed up for 6 months and they were divided into heart failure group and non heart failure group according to the complications of heart failure. The relationship between the parameters of cardiac color Doppler ultrasound and serum NT-proBNP level and heart failure in AMI patients after PCI was examined by multivariate logistic regression analysis method and the predictive value of cardiac color Doppler ultrasound parameters combined with serum NT-proBNP level in AMI patients with heart failure after PCI was analyzed by receiver operating characteristic (ROC) curve.
        RESULTS  Left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD) and Tei indexes in the study group were significantly higher than those in the control group (P<0.01), and left ventricular ejection fraction (LVEF) and the ratio of peak velocity of mitral flow in early diastolic phase (E) to peak velocity of mitral flow in late diastolic phase (A) (E/A) were significantly lower than those in the control group (P<0.01), and the serum NT proBNP level was significantly higher than that in the control group (P<0.01). Throughout the 6-month followed up, the complication rate of heart failure in the study group was 18.34% (31/169). The proportions of age ≥ 60 years(P<0.05), multiple infarction sites, hypertension, diabetes(P<0.05), hyperlipidemia(P<0.05), slow/no reflow after PCI in the heart failure group were higher than those in the non heart failure group (P<0.01) and the time from onset to admission in the heart failure group was longer than that in the non heart failure group (P<0.01). The number of coronary artery lesions, and LVEDD, LVESD and Tei index in the heart group were higher and LVEF and E/A were lower than those in the non heart failure group (P<0.01). Gensini score of coronary artery disease, cardiac troponin T (cTnT), creatine kinase MB (CK-MB), systolic blood pressure (SBP), diastolic blood pressure (DBP) and NT-proBNP levels in the heart failure group were higher than those in the non heart failure group (P<0.01). Multivariate analysis showed that the above indicators were the influencing factors of heart failure 6 months after PCI in AMI patients (P<0.01). ROC curve analysis showed that the sensitivity of LVEDD, LVESD, LVEF, E/A and Tei index, single and combined, to predict heart failure within 24 hours after PCI in AMI patients were 83.87%, 80.65%, 80.65%, 80.65%, 83.87% and 80.65% respectively, and the specificity were 75.36%, 76.09%, 78.26%, 76.81%, 76.09% and 94.20% respectively. The sensitivity of serum NT-proBNP level within 24 hours after PCI and its combination with whole heart color Doppler ultrasound parameters to predict heart failure after PCI in AMI patients were 83.87% and 96.77% respectively, and the specificity were 91.30% and 91.30% respectively.
        CONCLUSION  LVEDD, LVESD and Tei index of cardiac color Doppler ultrasound parameters are increased and LVEF and E/A are decreased within 24 hours after PCI in AMI patients, and the serum NT-proBNP level is abnormally increased, which all have the certain influences on the occurrence of heart failure in AMI patients after PCI and have the certain predictive values for the complicated heart failure. The combination of overall cardiac color Doppler parameters and serum NT-proBNP level has higher value. Age, time from onset to admission, numbers of coronary artery lesions, Gensini score, cTnT, CK-MB, blood pressure, infarct location, hypertension, diabetes, hyperlipidemia and postoperative reflux are also risk factors of heart failure in AMI patients after PCI.

       

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