右室应变对急性心肌梗死后恶性室性心律失常的预测价值分析
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摘要
目的探讨右室应变功能在预测急性心肌梗死(AMI)后恶性室性心律失常中的应用价值。方法对439例AMI患者行超声心动图检查,测量其常规超声参数及右室游离壁整体纵向峰值应变(RV-GLS)。于AMI后每个月行24 h动态心电图检查,以监测出现室性心律失常为随访终点,共随访12个月。根据AMI后是否发生恶性室性心律失常或因心律失常而入院或死亡,将患者分为发生事件组121例和未发生事件组318例。采用多因素回归模型分析RV-GLS对AMI后发生室性心律失常的预测价值。结果发生事件组年龄和Killip分级均大于未发生事件组,而三尖瓣环收缩期位移、RV-GLS及左室射血分数均低于未发生事件组(均P<0.05)。多因素回归分析显示RV-GLS是AMI后恶性室性心律失常发生风险的独立预测指标(OR=1.13,95%CI:1.01～1.86,P=0.005)。结论 RV-GLS是AMI后发生恶性室性心律失常风险的独立预测指标,准确评估AMI患者右室功能有助于临床采取有效措施降低心脑血管疾病的发生率和病死率,具有较好的应用价值。
Objective To explore the application value of right ventricular strain function in predicting malignantventricular arrhythmia after acute myocardial infarction(AMI).Methods A total of 439 patients with AMI were selected,andtheir routine ultrasound parameters were measured by echocardiography,and the global longitudinal peak strain(RV-GLS)of theright ventricular free wall was evaluated. 24 h dynamic electrocardiogram was performed every month after AMI. The end point offollow-up was monitoring ventricular arrhythmias. The patients were followed up for 12 months. According to the follow-upelectrocardiogram after AMI,the patients were divided into event group(n=121)and non-event group(n=318)to monitor whethermalignant ventricular arrhythmias occurred or whether they were hospitalized or died from arrhythmias. Multivariate regressionmodel was used to analyze the correlation between RV-GLS and ventricular arrhythmia after AMI.Results The age and Killipgrade of the event group were higher than those of the non-event group,while the systolic displacement of tricuspid annulus,RV-GLS and left ventricular ejection fraction of the event group were lower than those of the non-event group(all P<0.05).Multivariateregression analysis showed that RV-GLS was an independent predictor of the risk of ventricular arrhythmia after AMI(OR=1.13,95% CI:1.01～1.86,P=0.005).Conclusion RV-GLS is an independent predictor of the risk of ventricular arrhythmia inpatients with AMI. It is helpful to identify malignant arrhythmia in early stage,and can effectively reduce the incidence andmortality of cardiovascular and cerebrovascular diseases.
Objective To explore the application value of right ventricular strain function in predicting malignantventricular arrhythmia after acute myocardial infarction(AMI).Methods A total of 439 patients with AMI were selected,andtheir routine ultrasound parameters were measured by echocardiography,and the global longitudinal peak strain(RV-GLS)of theright ventricular free wall was evaluated. 24 h dynamic electrocardiogram was performed every month after AMI. The end point offollow-up was monitoring ventricular arrhythmias. The patients were followed up for 12 months. According to the follow-upelectrocardiogram after AMI,the patients were divided into event group(n=121)and non-event group(n=318)to monitor whethermalignant ventricular arrhythmias occurred or whether they were hospitalized or died from arrhythmias. Multivariate regressionmodel was used to analyze the correlation between RV-GLS and ventricular arrhythmia after AMI.Results The age and Killipgrade of the event group were higher than those of the non-event group,while the systolic displacement of tricuspid annulus,RV-GLS and left ventricular ejection fraction of the event group were lower than those of the non-event group(all P<0.05).Multivariateregression analysis showed that RV-GLS was an independent predictor of the risk of ventricular arrhythmia after AMI(OR=1.13,95% CI:1.01～1.86,P=0.005).Conclusion RV-GLS is an independent predictor of the risk of ventricular arrhythmia inpatients with AMI. It is helpful to identify malignant arrhythmia in early stage,and can effectively reduce the incidence andmortality of cardiovascular and cerebrovascular diseases.
引文
[1]Tai S,Tang JJ,Tang L,et al.Management and outcome of ventricular septal rupture complicating acute myocardial infarction:what is new in the era of percutaneous intervention[J]?Cardiology,2019,141(4):226-232.
[2]Lang RM,Badano LP,Moravi V,et al.Recommendations for cardiac chamber quantification by echocardiography in adults:an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging[J].J Am Soc Echocardiogr,2015,28(1):1-39.
[3]Gupta T,Harikrishnan P,Kolte D,et al.Outcomes of acute myocardial infarction in patients with hypertrophic cardiomyopathy[J].Am JMed,2015,128(8):879-887.
[4]Brienesse SC,Davies AJ,Khan A,et al.Prognostic value of LVEDP in acute myocardial infarction:a systematic review and Meta-analysis[J].J Cardiovasc Transl Res,2018,11(1):33-35.
[5]Lin LQ,Conway J,Alvarez S,et al.Reduced right ventricular fractional area change,strain,and strain rate before bidirectional cavopulmonary anastomosis is associated with medium-term mortality for children with hypoplastic left heart syndrome[J].J Am Soc Echocardiogr,2018,31(7):831-842.
[6]Ghio S,Temporelli PL,Klersy C,et al.Prognostic relevance of a noninvasive evaluation of right ventricular function and pulmonary artery pressure in patients with chronic heart failure[J].Eur J Heart Fail,2013,15(4):408-414.
[7]Gulati A,Ismail TF,Jabbour A,et al.The prevalence and prognostic significance of right ventricular systolic dysfunction in nonischemic dilated cardiomyopathy[J].Circulation,2013,128(15):1623-1633.
[8]Antoni ML,Scherptong RW,Atary JZ,et al.Prognostic value of right ventricular function in patients after acute myocar-dial infarction treated with primary percutaneous coronary intervention[J].Circ Cardiovasc Imaging,2010,3(3):264-271.
[9]Ersboll M,Valeur N,Andersen MJ,et al.Early echocardiographic deformation analysis for the prediction of sudden cardiac death and life-threatening arrhythmias after myocardial infarction[J].JACC Cardiovasc Imaging,2013,6(8):851-860.
[10]郑嘉荣,邢月贞,高丽,等.组织多普勒技术对2型糖尿病性心脏病患者右室功能的研究[J].临床超声医学杂志,2018,20(5):86-89.
[11]Risum N,Valeur N,S?gaard P,et al.Right ventricular function assessed by 2D strain analysis predicts ventricular arrhythmias and sudden cardiac death in patients after acute myocardial infarction[J].Eur Heart J Cardiovasc Imaging,2018,19(7):800-807.
[12]李赵欢,罗安果,邓燕,等.斑点追踪成像技术评价类风湿性关节炎患者右室收缩功能[J].临床超声医学杂志,2017,19(5):522-525.
[2]Lang RM,Badano LP,Moravi V,et al.Recommendations for cardiac chamber quantification by echocardiography in adults:an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging[J].J Am Soc Echocardiogr,2015,28(1):1-39.
[3]Gupta T,Harikrishnan P,Kolte D,et al.Outcomes of acute myocardial infarction in patients with hypertrophic cardiomyopathy[J].Am JMed,2015,128(8):879-887.
[4]Brienesse SC,Davies AJ,Khan A,et al.Prognostic value of LVEDP in acute myocardial infarction:a systematic review and Meta-analysis[J].J Cardiovasc Transl Res,2018,11(1):33-35.
[5]Lin LQ,Conway J,Alvarez S,et al.Reduced right ventricular fractional area change,strain,and strain rate before bidirectional cavopulmonary anastomosis is associated with medium-term mortality for children with hypoplastic left heart syndrome[J].J Am Soc Echocardiogr,2018,31(7):831-842.
[6]Ghio S,Temporelli PL,Klersy C,et al.Prognostic relevance of a noninvasive evaluation of right ventricular function and pulmonary artery pressure in patients with chronic heart failure[J].Eur J Heart Fail,2013,15(4):408-414.
[7]Gulati A,Ismail TF,Jabbour A,et al.The prevalence and prognostic significance of right ventricular systolic dysfunction in nonischemic dilated cardiomyopathy[J].Circulation,2013,128(15):1623-1633.
[8]Antoni ML,Scherptong RW,Atary JZ,et al.Prognostic value of right ventricular function in patients after acute myocar-dial infarction treated with primary percutaneous coronary intervention[J].Circ Cardiovasc Imaging,2010,3(3):264-271.
[9]Ersboll M,Valeur N,Andersen MJ,et al.Early echocardiographic deformation analysis for the prediction of sudden cardiac death and life-threatening arrhythmias after myocardial infarction[J].JACC Cardiovasc Imaging,2013,6(8):851-860.
[10]郑嘉荣,邢月贞,高丽,等.组织多普勒技术对2型糖尿病性心脏病患者右室功能的研究[J].临床超声医学杂志,2018,20(5):86-89.
[11]Risum N,Valeur N,S?gaard P,et al.Right ventricular function assessed by 2D strain analysis predicts ventricular arrhythmias and sudden cardiac death in patients after acute myocardial infarction[J].Eur Heart J Cardiovasc Imaging,2018,19(7):800-807.
[12]李赵欢,罗安果,邓燕,等.斑点追踪成像技术评价类风湿性关节炎患者右室收缩功能[J].临床超声医学杂志,2017,19(5):522-525.
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