摘要
目的 探讨经食管超声心动图评价卵圆孔未闭合并心房颤动(房颤)左心耳改变对主要心脑血管不良事件(MACCE)的相关因素研究.方法 选取2021年3月～2023年1月邯郸市第一医院收治的167例卵圆孔未闭合并房颤患者进行回顾性研究,根据6个月内MACCE发生情况分为MACCE组和无MACCE组.比较两组基线资料、左心耳射血分数(LAAEF)、左心耳血流平均排空速度(LAA-AEV)、左心耳最大容积(LAAVmax)、左心耳血流峰值排空速度(LAA-EV)、左心耳血流峰值充盈速度(LAA-FV)、左心耳血流平均充盈速度(LAA-AFV)、左心耳开口面积(LAA-O)、左心耳长径(LAA-L)、左心耳宽度(LAA-W),以随机森林算法对MACCE特征变量进行重要性排序,ROC分析经食管超声心动图参数预测MACCE价值.结果 MACCE组短暂性脑缺血发作史占比高于无MACCE组(27.27％比5.97％,P＜0.05);MACCE组LAAEF[(37.28±12.05)％比(49.20±10.34)％]、LAA-AEV[(29.43±7.29)cm/s 比(39.66±10.53)cm/s]、LAA-AFV[(24.35± 5.82)cm/s 比(35.29±9.10)cm/s]低于无MACCE组,LAA-W[(21.13±4.29)mm 比(18.74±3.06)mm]、自发显影判定分级高于无MACCE组(P＜0.05);将单因素分析P＜0.05变量作为随机森林算法的构成变量,逐步随机森林分析显示,MACCE特征重要排序前5变量预测因素为自发显影判定分级、LAA-AEV、LAA-AFV、LAAEF、LAA-W;ROC曲线显示,显影判定分级、LAA-AEV、LAA-AFV、LAAEF、LAA-W联合的AUC大于各参数单独预测,其中单一参数中自发显影判定分级的AUC最大.结论 卵圆孔未闭合并房颤患者采用经食管超声心动图观察其左心耳变化,自发显影判定分级、LAA-AEV、LAA-AFV、LAAEF、LAA-W联合预测患者MACCE具有较高价值.
Abstract
Objective To investigate the correlation between the left atrial appendage changes of atrial fibrillation(AF)with patent foramen ovale(PFO)and major adverse cardiovascular and cerebrovascular events(MACCE)by transesophageal echocardiography.Methods A retrospective study was conducted on 167 patients with atrial fibrillation and patent foramen ovale admitted to the Handan First Hospital from March 2021 to January 2023.According to the occurrence of MACCE within 6 months,the patients were divided into MACCE group and non-MACCE group.The baseline data,left atrial appendage ejection fraction(LAAEF),left atrial appendage average blood flow emptying velocity(LAA-AEV),left atrial appendage maximum volume(LAAVmax),left atrial appendage peak blood flow emptying velocity(LAA-EV),left atrial appendage peak blood flow filling velocity(LAA-FV),left atrial appendage average blood flow filling velocity(LAA-AFV),left atrial appendage opening area(LAA-O),left atrial appendage length(LAA-L),and left atrial appendage width(LAA-W)were compared between the two groups.The random forest algorithm was used to rank the importance of the characteristic variables of MACCE,and the ROC analysis was used to predict the value of MACCE using transesophageal echocardiographic parameters.Results The proportion of patients with a history of transient ischemic attack in the MACCE group was higher than that in the non-MACCE group(27.27％vs.5.97％,P＜0.05);the LAAEF[(37.28±12.05)％vs.(49.20±10.34)％],LAA-AEV[(29.43±7.29)cm/s vs.(39.66±10.53)cm/s],and LAA-AFV[(24.35±5.82)cm/s vs.(35.29±9.10)cm/s]in the MACCE group were lower than those in the non-MACCE group,while the LAA-W[(21.13±4.29)mm vs.(18.74±3.06)mm]and spontaneous visualization grading were higher than those in the non-MACCE group(P＜0.05).The univariate analysis with P＜0.05 variables as the constituent variables of the random forest algorithm showed that the top five predictive factors for spontaneous visualization grading,LAA-AEV,LAA-AFV,LAAEF,and LAA-W were ranked in the top five by importance in the MACCE group;the ROC curve showed that the combined AUC of spontaneous visualization grading,LAA-AEV,LAA-AFV,LAAEF,and LAA-W was greater than that of each parameter alone,with the AUC of spontaneous visualization grading being the largest among single parameters.Conclusion In patients with atrial fibrillation and patent foramen ovale,transesophageal echocardiography is used to observe changes in the left atrial appendage,and spontaneous imaging classification,LAA-AEV,LAA-AFV,LAAEF,and LAA-W are combined to predict MACCE in patients with high value.
维普
万方数据