实时三维超声心动图参数对急性心肌梗死患者PCI术后支架内再狭窄的预测价值

doi:10.3760/cma.j.cn441417-20240824-03002

国际医药卫生导报 ›› 2025, Vol. 31 ›› Issue (3): 360-365.DOI: 10.3760/cma.j.cn441417-20240824-03002

实时三维超声心动图参数对急性心肌梗死患者PCI术后支架内再狭窄的预测价值

黄新亮¹ 杜亚坤¹ 任红梅²

¹汉中市人民医院心血管内科，汉中 723000；²宁夏医科大学，银川 750004

收稿日期:2024-08-24 出版日期:2025-02-01 发布日期:2025-02-20
通讯作者: 杜亚坤，Email：shuduu133@163.com
基金资助:
国家自然科学基金（81760070）

Predictive value of real-time 3D echocardiographic parameters for in-stent restenosis after percutaneous coronary intervention in patients with acute myocardial infarction

Huang Xinliang¹, Du Yakun¹, Ren Hongmei²

¹Department of Cardiovascular Medicine, Hanzhong People's Hospital, Hanzhong 723000, China; ²Ningxia Medical University, Yinchuan 750004, China

Received:2024-08-24 Online:2025-02-01 Published:2025-02-20
Contact: Du Yakun, Email: shuduu133@163.com
Supported by:
National Natural Science Foundation of China (81760070)

摘要/Abstract

摘要：

目的　本研究旨在评估实时三维超声心动图参数预测急性心肌梗死患者经皮冠状动脉介入治疗（PCI）术后支架内再狭窄的价值。方法　本研究为回顾性分析。收集2019年7月至2022年1月在汉中市人民医院接受PCI术的100例急性心肌梗死患者临床资料。根据患者术后6个月内是否出现支架内再狭窄，将其分为再狭窄组（30例）和未狭窄组（70例）。比较两组患者的左心室功能和同步性参数。利用Lasso回归模型筛选再狭窄的关键特征变量，并通过受试者操作特征曲线（ROC）、校正曲线和决策曲线分析（DCA）评估变量的临床应用价值。采用独立样本t检验、χ²检验进行统计分析。结果　再狭窄组的左心室舒张末期容积（LVEDV）高于未狭窄组［（142.07±28.62）ml比（113.83±32.55）ml］，左心室射血分数（LVEF）、高峰射血速率（PER）/舒张末期容积（EDV）、高峰充盈速率（PFR）/EDV均低于未狭窄组［（46.77±4.26）%比（49.84±4.26）%）、（1.89±0.62）L/s比（2.47±0.87）L/s、（1.36±0.45）L/s比（1.77±0.68）L/s］，差异均有统计学意义（t=4.335、-3.312、-3.794、-3.598，均P<0.001）。通过Lasso回归分析对支架内再狭窄的特征变量进行筛选，得到5个特征变量，分别为LVEDV、LVEF和16段心肌达到最小收缩容积的时间标准差（Tmsv16-SD/R-R）、12段心肌达到最小收缩容积的时间标准差（Tmsv12-SD/R-R）、经心率校正的12段心肌达到最小收缩容积的时间最大差值（Tmsv12-Dif/R-R）。再狭窄组的风险评分低于未狭窄组［（0.02±0.99）分比（1.54±1.07）分］，差异有统计学意义（t=6.653，P<0.001）。ROC分析结果显示，Lasso风险评分的曲线下面积为0.866。结论　通过实时三维超声心动图和Lasso回归方法评估急性心肌梗死患者PCI术后的左心室功能和同步性，筛选关键特征变量预测PCI术后支架内再狭窄风险。

关键词:

急性心肌梗死, 经皮冠状动脉介入治疗, 实时三维超声心动图, 支架内再狭窄, 预测

Abstract:

Objective　To assess the value of real-time 3D echocardiographic parameters in predicting in-stent restenosis after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction. Methods　This study was a retrospective analysis. The clinical data of 100 patients with acute myocardial infarction who underwent PCI in Hanzhong People's Hospital from July 2019 to January 2022 were collected. The patients were divided into a restenosis group (30 cases) and a non-restenosis group (70 cases) according to in-stent restenosis within 6 months after surgery. The left ventricular function and synchronization parameters were compared between the two groups. Lasso regression modeling was used to screen out the key characteristic variables of restenosis, and the clinical value of the variables was evaluated by the receiver operating characteristic curve (ROC), calibration curve, and decision curve analysis (DCA). Independent sample t test and χ² test were used for statistical analysis. Results　The left ventricular end-diastolic volume (LVEDV) in the restenosis group was higher than that in the non-restenosis group [(142.07±28.62) ml vs. (113.83±32.55) ml], but the left ventricular ejection fraction (LVEF), peak ejection rate (PER)/end-diastolic volume (EDV), and peak filling rate (PFR)/EDV were all lower than those in the non-stenosis group [(46.77±4.26)% vs. (49.84±4.26)%, (1.89±0.62) L/s vs. (2.47±0.87) L/s, (1.36±0.45) L/s vs. (1.77±0.68) L/s], with statistically significant differences (t=4.335, -3.312, -3.794, and -3.598, all P<0.001). The characteristic variables of in-stent restenosis were screened by Lasso regression analysis, and 5 characteristic variables were obtained, including LVEDV, LVEF, Tmsv12-Dif/R-R, Tmsv12-SD/R-R, and Tmsv16-SD/R-R. The risk score of the restenosis group was lower than that of the non-restenosis group [(0.02±0.99) points vs. (1.54±1.07) points, t=6.653, P<0.001], and the area under the curve of the Lasso risk score was 0.866. Conclusions　In this study, we assessed left ventricular function and synchronization by real-time 3D echocardiography and LASSO regression in patients after PCI, screening key characteristic variables to predict restenosis risk.

Key words:

Acute myocardial infarction, Percutaneous coronary intervention, Real-time 3D echocardiography, In-stent restenosis, Prediction

黄新亮杜亚坤任红梅.

实时三维超声心动图参数对急性心肌梗死患者PCI术后支架内再狭窄的预测价值 [J]. 国际医药卫生导报, 2025, 31(3): 360-365.

Huang Xinliang, Du Yakun, Ren Hongmei.

Predictive value of real-time 3D echocardiographic parameters for in-stent restenosis after percutaneous coronary intervention in patients with acute myocardial infarction [J]. International Medicine and Health Guidance News, 2025, 31(3): 360-365.

参考文献

[1] Wang X, Hao G, Chen L, et al. Hypertension-mediated organ damage and established cardiovascular disease in patients with hypertension: the China hypertension survey, 2012-2015[J]. J Hum Hypertens, 2022, 36(12): 1092-1098. DOI: 10.1038/s41371-021-00635-z.
[2] 宋馨妍. 预防干预措施对冠心病PCI术后患者预防并发症的效果观察[J]. 罕少疾病杂志,2023,30(6):36-37,43. DOI:10.3969/j.issn.1009-3257.2023.06.016.
[3] 郗鸿飞,胡新央. 预测冠状动脉支架内再狭窄的炎症标志物[J]. 中华急诊医学杂志,2024,33(5):729-733. DOI:10.3760/cma.j.issn.1671-0282.2024.05.025.
[4] 王媛媛,褚静洁,赵航一,等. 实时三维超声心动图评价心肌梗死患者左心室收缩功能的应用价值[J]. 临床和实验医学杂志,2021,20(19):2120-2123. DOI:10.3969/j.issn.1671- 4695.2021.19.029.
[5] 杨柯柯. 实时三维超声心动图评价心肌梗死患者PCI前后左室收缩功能的应用价值研究[J]. 心血管病防治知识,2020,10(31):22-24. DOI:10.3969/j.issn.1672- 3015(x).2020.31.007.
[6] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会,«中国循环杂志»编辑委员会. 急性心肌梗死诊断和治疗指南[J]. 中华心血管病杂志,2001,29(12):710-725. DOI:10.3760/j:issn:0253-3758.2001.12.003.
[7] 孙少兵.冠脉介入术治疗冠心病不稳定型心绞痛患者的疗效及对心功能的影响[J].湖北民族大学学报(医学版),2023,40(2):86-88. DOI:10.13501/j.cnki.42-1590/r.2023. 02.004.
[8] 王丽玲. 早期经皮冠脉介入术在急性心肌梗死患者中的应用价值[J]. 中外医学研究,2021,19(23):73-75. DOI:10.14033/j.cnki.cfmr.2021.23.025.
[9] Beiras-Fernandez A, Ruf TF, Obadia JI, et al. Neochord anterior leaflet treatment to facilitate transcatheter mitral valve replacement with 3D real-time echocardiography[J]. Eur Heart J, 2020, 41(45): 4359. DOI: 10.1093/eurheartj/ehaa504.
[10] Zhao G, Joca HC, Nelson MT, et al. ATP- and voltage-dependent electro-metabolic signaling regulates blood flow in heart[J]. Proc Natl Acad Sci U S A, 2020, 117(13): 7461-7470. DOI: 10.1073/pnas.1922095117.
[11] Komai K, Kawasaki NK, Higa JK, et al. The role of ferroptosis in adverse left ventricular remodeling following acute myocardial infarction[J]. Cells, 2022, 11(9): 1399. DOI: 10.3390/cells11091399.
[12] 张杰,马礼坤,张理想,等. 急性心肌梗死患者院内死亡风险列线图预测模型的构建[J]. 临床心血管病杂志,2020,36(4):311-317. DOI:10.13201/j.issn.1001-1439.2020.04.004.
[13] 黄茜,郑少燕,张志英,等. 基于Lasso回归构建生物标志物影响代谢综合征的风险预测模型[J]. 中国疗养医学,2024,33(1):1-5. DOI:10.13517/j.cnki.ccm.2024.01.001.
[14] 严菁敏,陈莹,于洁,等. 基于LASSO-logistic回归的TB/HIV患者抗结核治疗结局影响因素研究[J]. 现代预防医学,2023,50(22):4039-4045,4051. DOI:10.20043/j.cnki.MPM.202306338.
[15] 王敏敏,石宇杰,崔振双,等. 冠状动脉支架内再狭窄危险因素的分析[J]. 中国循证心血管医学杂志,2021,13(6):716-718. DOI:10.3969/j.issn.1674-4055.2021.06.18.
[16] 杨琴. 冠状动脉支架术后辛伐他汀强化降脂对冠心病患者脂蛋白(a)水平及支架内再狭窄风险的影响[J]. 罕少疾病杂志,2018,25(6):14-15,18. DOI:10.3969/j.issn.1009- 3257.2018.06.006.
[17] 钱婷婷,孙蕾,李艳彬. 实时三维超声心动图参数对急性心肌梗死患者PCI术后6个月支架内再狭窄的预测价值[J]. 心电与循环,2023,42(3):207-212. DOI:10.12124/j.issn.2095-3933.2023.3.2021-4435.

实时三维超声心动图参数对急性心肌梗死患者PCI术后支架内再狭窄的预测价值

Predictive value of real-time 3D echocardiographic parameters for in-stent restenosis after percutaneous coronary intervention in patients with acute myocardial infarction

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