The predictive value of relative wall thickness on the prognosis of the patients with ST-segment elevation myocardial infarction
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摘要: 目的:评估左室相对室壁厚度(RWT)对急性ST段抬高型心肌梗死(STEMI)患者临床结局的预测价值。方法:2011年11月—2017年12月于南京鼓楼医院行急诊冠状动脉(冠脉)介入治疗的675例STEMI患者被纳入研究。有3种计算RWT的方法RWTPW=2×PWth/LVDd; RWTIVS+PW=(IVSth+PWth)/LVDd; RWTIVS=2×IVSth/LVDd(PWth:左室后壁厚度;LVDd:左室舒张末期内径;IVSth:室间隔厚度)。根据RWT的中位数分为低值组和高值组,比较两组的基线特征,评估两组患者5年心源性死亡和主要不良心血管事件(MACE)的发生率,并通过COX比例风险模型探讨RWT的预测价值。结果:RWTPW、RWTIVS+PW低值组的心源性死亡率和MACE事件累计发生率均高于高值组。RWTIVS组间生存分析无统计学意义。多因素COX回归模型显示RWTPW、RWTIVS+PW是STEMI患者发生远期心源性死亡及MCAE事件的独立预测指标。但亚组分析表明3种RWT计算方法对前壁心肌梗死患者临床结局没有预测价值,而RWTPW是非前壁心肌梗死的STEMI患者最稳定的独立预测指标(HR:0.56,95%CI:0.35~0.91,P=0.017)。结论:RWTPW、RWTIVS+PW以及RWTIVS对于前壁心肌梗死患者远期临床结局均无预测价值。对于STEMI中非前壁心肌梗死患者,RWTPW是最有效的独立预测指标。
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关键词:
- 左室相对室壁厚度 /
- 急性ST段抬高型心肌梗死 /
- 预后
Abstract: Objective: The study was performed to evaluate the prognostic value of relative wall thickness(RWT) in the patients with ST-segment elevation myocardial infarction(STEMI).Methods: A total of 675 STEMI patients who had undergone primary percutaneous coronary intervention(pPCI) were enrolled from November 2010 to December 2017 in Nanjing Drum Tower Hospital. There were three methods to calculate RWT: RWTPW=2×PWth/LVDd; RWTIVS+PW=(IVSth+PWth)/LVDd; RWTIVS=2×IVSth/LVDd(IVSth: intraventricular septal thickness; LVDd: LV diameter at end of diastole; PWth=posterior wall thickness). The patients were divided into two groups based on the three median values of the RWT and the baseline characteristics of the two groups were compared. The incidence rate of cardiac death and major adverse cardiac events(MACE) of the two groups at five years were assessed and COX proportional hazard models were established for evaluation of the predictive value of the RWT.Results: The incidence of cardiac death and MACE were both higher in the Low-RWTPWand Low-RWTIVS+PW group compared to the corresponding High group. But there was no statistical significance between the Low and High RWTIVS groups. Multiple COX regression analysis indicated that RWTPW and RWTIVS+PW were the independent predictors of the cardiac death and MACE in the patients with STEMI. But the subgroup analysis showed three calculation of RWT had no predictive value on the clinical outcome of the patients with anterior myocardial infarction. However, RWTPWwas the most reliable independent predictor of the long term prognosis in the patients with non-anterior wall group(HR: 0.56, 95%CI: 0.35-0.91, P=0.017).Conclusion: None of RWTPW, RWTIVS+PW and RWTIVS had predictive value on the long term clinical outcomes for the patients with anterior myocardial infarction. On the contrary, RWTPWwas the most effective predictors of the STEMI patientes with non-anterior infarction. -
[1] 中国心血管健康与疾病报告2019概要[J].中国循环杂志,2020,35(9):833-854.
[2] Cohn JN,Ferrari F,Sharpe N,et al.Cardiac remodeling-concepts and clinical implications:A consensus paper from an international forum on cardiac remodeling[J].JACC,2000,35(3):569-582.
[3] Chew DS,Heikki H,Schmidt G,et al.Change in left ventricular ejection fraction following first myocardial infarction and outcome[J].JACC Clin Electrophysiol,2018,4(5):672-682.
[4] Shindo K,Fukuda H,Hitsumoto T,et al.Plasma BNP levels and diuretics use as predictors of cardiovascular events in patients with myocardial infarction and impaired glucose tolerance[J].Cardiovascular Drugs and Therapy,2020,34(1):79-88.
[5] de Chickera S,Bota S,Kuwornu J,et al.Albuminuria,reduced kidney function,and the risk of ST-and non-ST-segment-elevation myocardial infarction[J].J Am Heart Associ,2018,7(20):e009995.
[6] Reinstadler S,Feistritzer H,Klug G,et al.High-sensitivity troponin T for prediction of left ventricular function and infarct size one year following ST-elevation myocardial infarction[J].In J Cardiol,2016,202:188-193.
[7] 陈凤敏,郑杨,高明.空腹三酰甘油水平对急性ST段抬高型心肌梗死患者远期预后的影响[J].临床心血管病杂志,2019,35(5),412-415.
[8] 张芹,程毅松,贾禹.中性粒细胞百分比与白蛋白比值对急性ST段抬高型心肌梗死患者预后的预测价值分析[J].临床急诊杂志,2020,21(5):354-358.
[9] Hashem MS,Kalashyan H,Choy J,et al.Left ventricular relative wall thickness versus left ventricular mass index in non-cardioembolic stroke patients[J].Medicine(Baltimore),2015,94(20):e872.
[10] Yamaguchi S,Shimabukuro M,Abe M,et al.Comparison of the prognostic values of three calculation methods for echocardiographic relative wall thickness in acute decompensated heart failure[J].Cardiovasc Ultrasound,2019,17(1):30.
[11] Biton Y,Goldenberg I,Kutyifa V,et al.Relative wall thickness and the risk for ventricular tachyarrhythmias in patients with left ventricular dysfunction[J].J Am Coll Cardiol,2016,67(3):303-312.
[12] O'Gara PT,Kushner FG,Ascheim DD,et al.2013ACCF/AHA guideline for the management of ST-elevation myocardial infarction:executive summary:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines:developed in collaboration with the American College of Emergency Physicians and Society for Cardiovascular Angiography and Interventions[J].Catheter Cardiovasc Interv,2013,82(1):E1-27.
[13] Ibanez B,James S,Agewall S,et al.2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation:The Task Force for the management of acute myocardial infarction in patients presenting with STsegment elevation of the European Society of Cardiology( ESC)[J].Eur Heart J,2018,39(2):119-177.
[14] Gulati R,Behfar A,Narula J,et al.Acute myocardial infarction in young individuals[J].Mayo Clin Proc,2020,95(1):136-156.
[15] Tezuka Y,Iguchi M,Hamatani Y,et al.Association between relative wall thickness of left ventricle and incidence of thromboembolism in patients with non-valvular atrial fibrillation:The Fushimi AF Registry[J].Eur Heart J Qual Care Clin Outcomes,2020,33:120.
[16] Lang RM,Badano LP,Mor-Avi 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 Echocardio,2015,28(1):1-U170.
[17] Chahal NS,Lim TK,Jain P,et al.New insights into the relationship of left ventricular geometry and left ventricular mass with cardiac function:apopulation study of hypertensive subjects[J].Euro Heart J,2010,31(5):588-594.
[18] 杨胜利.急性冠脉综合征触发的病理生理机制[J].中国血液流变学杂志,2003,11(1):88-92.
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