在急性心肌梗塞后左心室重塑的最佳定义和预测名图
Sicheng Zhang1,2,3,4, Zheng Zhu5, Manqing Luo1,2,3,4
1Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.
ESC heart failure
|July 25, 2023
概括
在心肌梗塞后的左心室重塑预示着不良结果. 通过左心室喷射分数 (LVEF) 定义重塑对于预测死亡率至关重要,新的名谱有助于识别有风险的患者.
科学领域:
- 心脏病学 心脏病学
- 心血管研究研究心血管研究
- 医学诊断 医学诊断 医学诊断
背景情况:
- 急性心肌梗塞 (AMI) 后的左心室 (LV) 重塑与心力衰竭和死亡率有关.
- 在LV改造定义上缺乏共识,阻碍了预后评估.
- 之前的研究没有比较不同LV改造定义的预后价值.
研究的目的:
- 为了确定AMI后LV改造的最佳定义.
- 开发一种预测性名谱,用于识别患有LV重塑风险的患者.
- 创建一个在线计算器来评估LV改造风险.
主要方法:
- 对829名接受穿皮冠状动脉干预的AMI患者进行前性观察研究.
- 在入院时进行心声扫描,并在6个月后评估LV重塑 (定义为LVEDV,LVESV或LVEF).
- 拉索和多变量逻辑回归用于名图开发;AUC,校准和决策曲线分析用于验证.
主要成果:
- LV 重塑的发生率为24.85% (LVEDV),28.71% (LVESV) 和14.60% (LVEF).
- 所有定义独立地预测了复合终点,但只有LVEF定义的改造预测了所有原因的死亡率 (HR 2.78).
- 一个7个变量名图 (包括BP,HR,AMI类型,支架长度,NT-proBNP,troponin I,葡萄糖) 显示出良好的预测性能 (AUC 0.766).
结论:
- 根据各种定义,LV重塑预测PCI后AMI患者的长期不良结果.
- 左心室喷射率 (LVEF) <50%是预测所有原因死亡率的最合适的定义.
- 开发的诺米图提供了一个准确和有效的工具,用于预测心脏病发作后的LV重塑.
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