目的 通过心脏超声多普勒检测左心房容积指数(left atrial volume index,LAVI)和左心室舒张功能来预测急性ST段抬高型心肌梗死(ST-segment elevated myocardial infarction, STEMI)患者血运重建术后的持续性房颤(atrial fibrillation,AF)发生风险。方法 纳入2013-01至2017-12因STEMI入武警陕西总队医院心血管内科行初次经皮冠状动脉介入(percutaneous coronary intervention,PCI)手术的患者256例。多普勒超声心动图检测PCI术后患者左房容积和LAVI。随访时间2年,主要终点事件定义为2年内新诊断的持续时间大于7 d的持续性心房颤动。受试者工作曲线(receiver operation curve,ROC)确定左房内径的最佳截断值。logistics分析终点事件发生的独立预测因素。结果 LAVI大于31 ml/m2患者2年内发生主要终点事件风险增高,预测敏感度0.89,特异度0.60,约登指数0.49。具有左心室舒张功能不全(left ventricular diastolic dysfunction,LVDD)的患者2年内的主要终点事件发生风险显著增高,预测敏感度0.76,特异度0.74,约登指数0.50。同时合并LVDD和左心房容积指数增大预测2年内主要终点事件发生风险敏感度为0.85,特异度为0.89,约登指数0.74。Logistics多元回归模型发现随访期内再发ACS事件,左前降支病变,LVDD和左心室容积指数增大均为2年内主要终点事件发生的独立危险因素。结论 左心房增大和LVDD是STEMI患者血运重建后发生持续性房颤的独立预测因子。PCI术后LAVI联合左心室舒张功能可预测患者持续性房颤的发生风险。
Abstract
ObjectiveTo predict the occurrence of persistent atrial fibrillation after revascularization in patients with acute ST-segment elevation myocardial infarction (STEMI) by detecting the left atrial volume index (LAVI) and left ventricular function with echocardiographic Doppler.Methods A total of 256 patients who underwent emergency primary coronary intervention (PCI) in our hospital due to STEMI between January 2013 and December 2017 were enrolled in this study. Doppler echocardiography was used to detect the left atrial volume and LAVI. The follow-up lasted 2 years. The primary endpoint was defined as persistent atrial fibrillation with a duration of more than 7 days that was newly diagnosed within 2 years. The receiver operating curve (ROC) was used to determine the optimal cutoff for the left atrial diameter. Logistics regression analysis was used to identify independent predictors of endpoint events.Results Patients with an LAVI greater than 31 ml/m2 had a significantly higher risk of primary endpoint events within 2 years, with a predictive sensitivity of 0.89, a specificity of 0.60, and an approximated index of 0.49. Patients with left ventricular diastolic dysfunction (LVDD) had a significantly increased risk of primary endpoint events within 2 years, with a predictive sensitivity of 0.76, a specificity of 0.74, and an approximated index of 0.50, compared with 0.85, 0.89 and 0.74 for the combination of the LVDD and left atrial volume index. The multiple regression model of Logistics found that the recurrence of acute coronary events, left anterior descending artery lesions, LVDD and left ventricular volume index increase were independent risk factors for primary endpoint event within 2 years.Conclusions Left atrial enlargement and LVDD are independent predictors of persistent atrial fibrillation after revascularization in STEMI patients. The left atrial volume index combined with left ventricular diastolic function after PCI can help predict the risk of persistent atrial fibrillation in patients.
关键词
左心室舒张功能不全 /
左房容积指数 /
持续性房颤 /
急性冠脉综合征
Key words
left ventricular diastolic dysfunction /
left atrial volume index /
persistent atrial fibrillation /
acute coronary syndrome
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