Assessment value of myocardial contrast echocardiography for viable myocardium and clinical prognosis in patients with acute myocardial infarction after percutaneous oronary intervention
Objective To investigate the assessment value of myocardial contrast echocardiography(MCE)for viable myocardium and clinical prognosis in patients with acute myocardial infarction(AMI)after percutaneous oronary intervention(PCI).Methods Clinical data of 100 AMI patients from October 2021 to January 2023 at the Fourth People's Hospital of Zigong City were retrospectively selected.Patients with major adverse cardiovascular events(MACE)within 6 months after PCI were included in the poor prognosis group(21 cases),while those without MACE were included in the good prognosis group(79 cases).Using echocardiography improvement of left ventricular regional wall motion abnormality as the gold standard,the results of MCE detecting viable myocardium were recorded.The clinical data,cardiac function indexes and MCE quantitative parameters were compared between the two groups.Spearman correlation analysis was performed to assess the correlation between MCE quantitative parameters,cardiac function indicators,and the segments of viable myocardium.Pearson correlation analysis was used to examine the relationship between MCE quantitative parameters and cardiac function indicators.Logistic regression analysis was conducted to determine the relationship between MCE quantitative parameters and clinical prognosis in AMI patients after PCI.ROC curve was used to evaluate the predictive value of MCE quantitative parameters for prognosis in patients with AMI after PCI.Results The sensitivity,specificity,and accuracy of MCE in determining the viable myocardium in AMI patients were 92.55%,90.91%,and 91.97%,respectively.The proportion of patients with less than 4 segments of viable myocardium in the poor prognosis group was higher than that in the good prognosis group,the cardiac function indicators including left ventricular ejection fraction(LVEF)and left ventricular fractional shortening(LVFS)3 months post-operation were lower in the poor prognosis group compared to the good prognosis group(χ2/t=4.571,2.883,2.948;P＜0.05).The MCE quantitative parameters of peak intensity(A),curve slope(β),and myocardial blood flow(A·β)in the poor prognosis group were lower than those in the good prognosis group,while the perfusion score index(PSI)was higher than that in the good prognosis group(t=3.077,2.393,3.831,2.989;P＜0.05).A,β,A·β,LVEF and LVFS in AMI patients were positively correlated with the segments of viable myocardium,while PSI was negatively correlated(r=0.652,0.609,0.667,0.685,0.647,-0.627;P＜0.01).Three months after PCI,PSI in AMI patients was negatively correlated with LVEF and LVFS,while A,β,and A·β were positively correlated with LVFS and LVEF(r=-0.801,-0.662,0.705,0.781,0.752,0.727,0.593,0.654;P＜0.05).Logistic regression analysis showed that A,β,A·β,and PSI at 3 months post-PCI were all associated with clinical prognosis of AMI patients after PCI(OR=4.322,3.672,6.670,0.648;P＜0.01).MCE quantitative parameters A,β,A·β,and PSI at 3 months post-PCI could predict the prognosis of AMI patients.The area under the curve of the combined prediction is 0.945,and the prediction efficiency was higher than that of each parameter alone.Conclusion MCE can evaluate the myocardial viability in AMI patients,and the quantitative parameters A,β,A·β,and PSI are effective in predicting the prognosis of AMI patients after PCI.
万方数据
维普
