心电心音图对急性心肌梗死后早期心室重构的预测价值

曾晓娟; 张亮; 王维维; 赵磊; 李燕秋; 司良毅

doi:10.16016/j.2097-0927.202303164

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心电心音图对急性心肌梗死后早期心室重构的预测价值

临床医学 | 更新时间：2026-01-09

- 心电心音图对急性心肌梗死后早期心室重构的预测价值
- Predictive value of acoustic cardiogram for early-stage ventricular remodeling after acute myocardial infarction: an analysis of 102 cases
- 陆军军医大学学报 2023年45卷第18期页码：1983-1989
- 作者机构：
  
  401120 重庆，重庆医科大学附属第三医院心血管内科
- 作者简介：
  
  [ 司良毅, E-mail: 650273@hospital.cqmu.edu.cn SI Liangyi, E-mail: 650273@hospital.cqmu.edu.cn
- 基金信息：
- DOI：10.16016/j.2097-0927.202303164
  中图分类号： R364.33;R540.44;R542.22
- 收稿：2023-03-27，
  
  修回：2023-05-26，
  
  纸质出版：2023-09-30
- 稿件说明：
移动端阅览
曾晓娟, 张亮, 王维维, 等. 心电心音图对急性心肌梗死后早期心室重构的预测价值[J]. 陆军军医大学学报, 2023,45(18):1983-1989.

Xiaojuan ZENG, Liang ZHANG, Weiwei WANG, et al. Predictive value of acoustic cardiogram for early-stage ventricular remodeling after acute myocardial infarction: an analysis of 102 cases[J]. Journal of Army Medical University, 2023, 45(18): 1983-1989.
曾晓娟, 张亮, 王维维, 等. 心电心音图对急性心肌梗死后早期心室重构的预测价值[J]. 陆军军医大学学报, 2023,45(18):1983-1989. DOI： 10.16016/j.2097-0927.202303164.

Xiaojuan ZENG, Liang ZHANG, Weiwei WANG, et al. Predictive value of acoustic cardiogram for early-stage ventricular remodeling after acute myocardial infarction: an analysis of 102 cases[J]. Journal of Army Medical University, 2023, 45(18): 1983-1989. DOI： 10.16016/j.2097-0927.202303164.

摘要

目的

探讨心电心音图参数对急性心肌梗死后早期心室重构的预测价值。

方法

纳入重庆医科大学附属第三医院心血管内科2021年6月至2022年2月入院后接受经皮冠状动脉介入治疗(percutaneous coronary intervention surgery，PCI)的急性心肌梗死(acute myocardial infarction，AMI)患者102例。对患者进行心电图、心脏超声、心肌损伤标志物、BNP和心电心音图检查。根据心脏超声左室射血分数(left ventricular ejection fraction，LVEF)测定结果，将患者分为早期心室重构(early ventricular remodeling，EVR)组(LVEF<50%，50例)和对照组(LVEF≥50%，52例)，比较两组患者的基线数据和心电心音图参数。采用多因素logistic回归分析EVR的独立预测因素。采用受试者工作特征(receiver operating characteristic，ROC)曲线下面积(area under the curve，AUC)评估独立预测因素对EVR的预测价值。

结果

EVR组的心电心音图参数电机械激动时间比值(electromechanical activation time divided by the cardiac cycle length，EMATc)、左室收缩时间比值(left ve

ntricular systolic time divided by the cardiac cycle length，LVSTc)、第四心音强度(fourth heart sound，S4)、左室收缩功能障碍指数(systolic dysfunction index，SDI)均显著高于对照组(

＜0.05)。logistic回归分析结果提示，在基线数据和心电心音图参数中，男性(

=53.20，95%

: 3.80~1 349.00，

=0.007)、心电心音图参数EMATc(

=2.62，95%

：1.77~4.30，

0.001)和心脏超声左室舒张末期内径(left ventricular end diastolic dimension，LVEDD；

=1.19，95%

: 1.03~1.42，

=0.029)进入最终的logistic回归模型中。EMATc水平可较好区分EVR患者(AUC=0.892，95%

: 0.834~0.949，

0.001)，当临界点设置为11.50时，敏感度可达76.0%。心脏超声参数LVEDD的最佳临界值为49.50 mm，特异度为86.5%，具有较高的排除诊断价值。

结论

心电心音图参数EMATc可用于预测急性心肌梗死后早期心室重构。

Abstract

Objective

To investigate the predictive value of acoustic cardiographic parameters for post-acute myocardial infarction (AMI) early ventricular remodeling (EVR).

Methods

A total of 102 AMI patients undergoing percutaneous coronary intervention (PCI) in our hospital during June 2021 and February 2022 were recruited in this study. Electrocardiography

cardiac Doppler ultrasound examination

and acoustic cardiography were performed for all of them. Their biomarkers of cardiac injury and brain natriuretic peptide (BNP) were detected and recorded. According to the value of left ventricular ejection fraction (LVEF)

they were and divided into EVR group (

50%

=50) and control group (≥50%

=52). The baseline data and acoustic cardiographic parameters were compared between the 2 groups. Multivariate logistic regression analysis was applied to analyze the independent predictors for EVR

and the area under the curve (AUC) of receiver operating characteristic (ROC) were conducted to evaluate the predictive performances of these predictive factors.

Results

Among the acoustic cardiographic parameters

significantly higher electromechanical activation time divided by the cardiac cycle length (EMATc)

left ventricular systolic time divided by the cardiac cycle length (LVSTc)

fourth heart sound (S4) strength

and systolic dysfunction index (SDI) were observed in the EVR group than the control group (

0.05). And in the clinical data and acoustic cardiographic parameters

male (

=53.20

95%

: 3.80~1 349.00

=0.007)

EMATc (

=2.62

95%

: 1.77~4.30

0.001) and LVEDD (

=1.19

95%

: 1.03~1.42

=0.029) finally entered in the logistic regression model in a logistic regression model predicting EVR. EMATc level could satisfactorily distinguish those patients with EVR (AUC=0.892

95%

: 0.834~0.949

0.001)

and when the cut-off point was set as 11.50

the sensitivity could be up to 76.0%. LVEDD level at an optimal cut-off value of 49.50 mm yielded a specificity of 86.5%

providing evidence for an exclusion diagnosis.

Conclusion

Acoustic cardiographic parameter EMATc is an independent predictor for EVR in AMI patients.

关键词

Keywords

references

ONG S B, HERNÁNDEZ-RESÉNDIZ S, CRESPO-AVILAN G E, et al . Inflammation following acute myocardial infarction: multiple players, dynamic roles, and novel therapeutic opportunities[J ] . Pharmacol Ther, 2018, 186: 73-87. DOI: 10.1016/j.pharmthera.2018.01.001.

TURKIEH A, FERTIN M, BOUVET M, et al . Expression and implication of clusterin in left ventricular remodeling after myocardial infarction[J ] . Circ Heart Fail, 2018, 11(6): e004838. DOI: 10.1161/CIRCHEARTFAILURE.117.004838.

KEELEY E C, BOURA J A, GRINES C L. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials[J]. Lancet, 2003, 361(9351): 13-20. DOI: 10.1016/S0140-6736(03)12113-7.

WESTMAN P C, LIPINSKI M J, LUGER D, et al . Inflammation as a driver of adverse left ventricular remodeling after acute myocardial infarction[J ] . J Am Coll Cardiol, 2016, 67(17): 2050-2060. DOI: 10.1016/j.jacc.2016.01.073.

COHN J N, FERRARI R, SHARPE N. Cardiac remodeling: concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an International Forum on Cardiac Remodeling[J]. J Am Coll Cardiol, 2000, 35(3): 569-582. DOI: 10.1016/s0735-1097(99)00630-0.

WEIR R A P, MCMURRAY J J V, VELAZQUEZ E J. Epidemiology of heart failure and left ventricular systolic dysfunction after acute myocardial infarction: prevalence, clinical characteristics, and prognostic importance[J]. Am J Cardiol, 2006, 97(10): 13-25. DOI: 10.1016/j.amjcard.2006.03.005.

ERLEBACHER J A, WEISS J L, WEISFELDT M L, et al . Early dilation of the infarcted segment in acute transmural myocardial infarction: role of infarct expansion in acute left ventricular enlargement[J ] . J Am Coll Cardiol, 1984, 4(2): 201-208. DOI: 10.1016/S0735-1097(84)80203-X.

PFEFFER M A, BRAUNWALD E. Ventricular remodeling after myocardial infarction. Experimental observations and clinical implications[J]. Circulation, 1990, 81(4): 1161-1172. DOI: 10.1161/01.cir.81.4.1161.

ST JOHN SUTTON M, SCOTT C H. A prediction rule for left ventricular dilatation post-MI?[J]. Eur Heart J, 2002, 23(7): 509-511. DOI: 10.1053/euhj.2001.3026.

中国医师协会胸痛专业委员会, 中华心血管病杂志(网络版)编辑委员会, 急性心肌梗死后心室重构防治专家共识起草组. 急性心肌梗死后心室重构防治专家共识[J]. 中华心血管病杂志(网络版), 2020, 3(1): 1-7. DOI: 10.3760/cma.j.issn.2096-1588.2020.1000051.

Chest Pain Professional Committee of Chinese Medical Doctor Association, Editorial Committee of Chinese Journal of Cardiovascular Disease (Online Edition), Expert Consensus Drafting Group for the Prevention and Treatment of Ventricular Remodeling after Acute Myocardial Infarction. Expert consensus on the prevention and treatment of ventricular remodeling after acute myocardial infarction [J ] . Chin J Cardiovasc Dis (Online Edition), 2020, 3 (1): 1-7. DOI: 10.3760/cma.j.issn.2096-1588.2020.1000051.

WANG S, FANG F, LIU M, et al . Rapid bedside identification of high-risk population in heart failure with reduced ejection fraction by acoustic cardiography[J ] . Int J Cardiol, 2013, 168(3): 1881-1886. DOI: 10.1016/j.ijcard.2012.12.064.

ROOS M, TOGGWEILER S, JAMSHIDI P, et al . Noninvasive detection of left ventricular systolic dysfunction by acoustic cardiography in cardiac failure patients[J ] . J Cardiac Fail, 2008, 14(4): 310-319. DOI: 10.1016/j.cardfail.2007.12.004.

LEE E, DREW B J, SELVESTER R H, et al . Diastolic heart sounds as an adjunctive diagnostic tool with ST criteria for acute myocardial ischemia[J ] . Acute Cardiac Care, 2009, 11(4): 229-235. DOI: 10.1080/17482940903203071.

DILLIER R, KOBZA R, ERNE S, et al . Noninvasive detection of left-ventricular systolic dysfunction by acoustic cardiography in atrial fibrillation[J ] . Cardiol Res Pract, 2011, 2011: 1-7. DOI: 10.4061/2011/173102.

ZHANG F W, ZHANG Y X, SI L Y, et al . Value of acoustic cardiography in the clinical diagnosis of coronary heart disease[J ] . Clin Cardiol, 2021, 44(10): 1386-1392. DOI: 10.1002/clc.23694.

WEN Y N, LEE A P W, FANG F, et al . Beyond auscultation: acoustic cardiography in clinical practice[J ] . Int J Cardiol, 2014, 172(3): 548-560. DOI: 10.1016/j.ijcard.2013.12.298.

BAUTERS C, DUBOIS E, POROUCHANI S, et al . Long-term prognostic impact of left ventricular remodeling after a first myocardial infarction in modern clinical practice[J ] . PLoS One, 2017, 12(11): e0188884. DOI: 10.1371/journal.pone.0188884.

BRAUNWALD E. Biomarkers in heart failure. Preface[J]. Heart Fail Clin, 2009, 5(4): xiii-xiv. . DOI: 10.1016/j.hfc.2009.05.002

NAGAYA N, NISHIKIMI T, GOTO Y, et al . Plasma brain natriuretic peptide is a biochemical marker for the prediction of progressive ventricular remodeling after acute myocardial infarction[J ] . Am Heart J, 1998, 135(1): 21-28. DO I: 10.1016/S0002-8703(98)70338-2.

NILSSON J C, GROENNING B A, NIELSEN G, et al . Left ventricular remodeling in the first year after acute myocardial infarction and the predictive value of N-terminal pro brain natriuretic peptide[J ] . Am Heart J, 2002, 143(4): 696-702. DOI: 10.1067/mhj.2002.120293.

FERTIN M, HENNACHE B, HAMON M, et al . Usefulness of serial assessment of B-type natriuretic peptide, troponin Ⅰ, and C-reactive protein to predict left ventricular remodeling after acute myocardial infarction (from the REVE-2 study)[J ] . Am J Cardiol, 2010, 106(10): 1410-1416. DOI: 10.1016/j.amjcard.2010.06.071.

HSIAO J F, CHUNG C M, CHU C M, et al . Two-dimensional speckle tracking echocardiography predict left ventricular remodeling after acute myocardial infarction in patients with preserved ejection fraction[J ] . PLoS One, 2016, 11(12): e0168109. DOI: 10.1371/journal.pone.0168109.

ECHOUFFO-TCHEUGUI J B, ERQOU S, BUTLER J, et al . Assessing the risk of progression from asymptomatic left ventricular dysfunction to overt heart failure[J ] . JACC Heart Fail, 2016, 4(4): 237-248. DOI: 10.1016/j.jchf.2015.09.015.

COKKINOS D V, BELOGIANNEAS C. Left ventricular remodelling: a problem in search of solutions[J]. Eur Cardiol, 2016, 11(1): 29-35. DOI: 10.15420/ecr.2015:9:3.

BHATT A S, AMBROSY A P, VELAZQUEZ E J. Adverse remodeling and reverse remodeling after myocardial infarction[J]. Curr Cardiol Rep, 2017, 19(8): 71. DOI: 10.1007/s11886-017-0876-4.

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