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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