[Predictive value of coronary microcirculation dysfunction after revascularization in patients with acute myocardial infarction for acute heart failure during hospitalization].

Q3 Medicine
北京大学学报(医学版) Pub Date : 2025-04-18
Lan Wang, Yuliang Ma, Weimin Wang, Tiangang Zhu, Wenying Jin, Hong Zhao, Chengfu Cao, Jing Wang, Bailin Jiang
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引用次数: 0

Abstract

Objective: To study incident and clinical characteristics of the coronary microcirculation dysfunction (CMD) in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) by myocardial contrast echocardiography (MCE) and to explore the predictive value of CMD for in-hospital acute heart failure event.

Methods: One hundred and forty five patients with AMI who had received PCI and completed MCE during hospitalization in Peking University People' s Hospital from November 2015 to July 2021 were enrolled in our study. The patients were divided into CMD group and normal group according to the coronary microcirculation status detected by MCE. Clinical data and MCE data of the two groups were collected and analyzed. The acute heart failure event during hospitalization was described. A multivariate Logistic regression model was built to analyze the risk of acute heart failure in patients with CMD. A receiver operating characteristic (ROC) curve was drawn to evaluate the value of CMD in predicting acute heart failure event.

Results: CMD detected by MCE occurred in 87 patients (60%). Compared with normal group, patients with CMD had higher troponin I (TnI) peak level [52.8 (8.1, 84.0) μg/L vs. 18.9 (5.7, 56.1) μg/L, P=0.005], poorer Killip grade on admission (P=0.030), different culprit vessel (P < 0.001) and more patients had thrombolysis in myocardial infarction (TIMI) flow pre-PCI less than grade 3 in culprit vessel (65.1% vs. 43.1%, P=0.025). Meanwhile, patients with CMD had poorer left ventricular ejection fraction (LVEF) [52% (43%, 58%) vs. 61% (54%, 66%)], poorer global longitudinal strain (GLS) [-11.2% (-8.7%, -14.0%) vs.-13.9% (-10.8%, -17.0%)] and worse wall motion score index (WMSI) (1.58±0.36 vs. 1.25± 0.24) (P all < 0.001). Acute left heart failure happened in 13.8% of the CMD patients, which were significant higher than that in the patients with normal coronary microcirculation perfusion (1.7%, P=0.013). After correcting for the culprit vessel, the TIMI flow pre-PCI in the culprit vessel and the peak TnI value, the risk of acute left heart failure in the patients with CMD was still high (OR=9.120, 95%CI: 1.152-72.192, P=0.036). The area under ROC curve (AUC) was 0.677 (95%CI: 0.551-0.804, P=0.035).

Conclusion: The incidence of CMD detected by MCE in patients with AMI post-PCI was 60%. Patients with CMD have a higher risk of acute left heart failure during hospitalization.

[急性心肌梗死急性心力衰竭住院期间冠状动脉微循环功能障碍的预测价值]。
目的:通过心肌超声造影(MCE)研究急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后冠状动脉微循环功能障碍(CMD)的发生及临床特点,探讨CMD对院内急性心力衰竭事件的预测价值。方法:选取2015年11月至2021年7月北京大学人民医院住院期间行PCI并完成MCE的AMI患者145例。根据MCE检测的冠状动脉微循环情况分为CMD组和正常组。收集两组患者的临床资料及MCE资料进行分析。急性心力衰竭事件住院期间进行了描述。建立多因素Logistic回归模型,分析CMD患者发生急性心力衰竭的风险。绘制受试者工作特征(ROC)曲线,评价CMD对急性心力衰竭事件的预测价值。结果:MCE检出CMD 87例(60%)。与正常组相比,CMD患者肌钙蛋白I (TnI)峰值水平较高[52.8 (8.1,84.0)μg/L比18.9 (5.7,56.1)μg/L, P=0.005],入院时Killip分级较差(P=0.030),罪魁血管不同(P < 0.001), pci前心肌梗死溶栓(TIMI)血流低于3级的患者较多(65.1%比43.1%,P=0.025)。同时,CMD患者左室射血分数(LVEF)较差[52%(43%,58%)比61%(54%,66%)],整体纵向应变(GLS)较差[-11.2%(-8.7%,-14.0%)比-13.9%(-10.8%,-17.0%)],壁运动评分指数(WMSI)较差(1.58±0.36比1.25±0.24)(P均< 0.001)。CMD患者发生急性左心衰的比例为13.8%,显著高于冠脉微循环灌注正常患者(1.7%,P=0.013)。在校正了元凶血管、pci前元凶血管的TIMI血流及TnI峰值后,CMD患者发生急性左心功能衰竭的风险仍然很高(OR=9.120, 95%CI: 1.152 ~ 72.192, P=0.036)。ROC曲线下面积(AUC)为0.677 (95%CI: 0.551 ~ 0.804, P=0.035)。结论:MCE检测AMI pci术后CMD的发生率为60%。CMD患者在住院期间发生急性左心衰竭的风险较高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
北京大学学报(医学版)
北京大学学报(医学版) Medicine-Medicine (all)
CiteScore
0.80
自引率
0.00%
发文量
9815
期刊介绍: Beijing Da Xue Xue Bao Yi Xue Ban / Journal of Peking University (Health Sciences), established in 1959, is a national academic journal sponsored by Peking University, and its former name is Journal of Beijing Medical University. The coverage of the Journal includes basic medical sciences, clinical medicine, oral medicine, surgery, public health and epidemiology, pharmacology and pharmacy. Over the last few years, the Journal has published articles and reports covering major topics in the different special issues (e.g. research on disease genome, theory of drug withdrawal, mechanism and prevention of cardiovascular and cerebrovascular diseases, stomatology, orthopaedic, public health, urology and reproductive medicine). All the topics involve latest advances in medical sciences, hot topics in specific specialties, and prevention and treatment of major diseases. The Journal has been indexed and abstracted by PubMed Central (PMC), MEDLINE/PubMed, EBSCO, Embase, Scopus, Chemical Abstracts (CA), Western Pacific Region Index Medicus (WPR), JSTChina, and almost all the Chinese sciences and technical index systems, including Chinese Science and Technology Paper Citation Database (CSTPCD), Chinese Science Citation Database (CSCD), China BioMedical Bibliographic Database (CBM), CMCI, Chinese Biological Abstracts, China National Academic Magazine Data-Base (CNKI), Wanfang Data (ChinaInfo), etc.
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