Clinical value of two-dimensional echocardiography in evaluating the severity of non-ST- segment elevation myocardial infarction in the elderly
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摘要:
目的 研究超声心动图（2DE）在评估老年非ST抬高型心肌梗死（NSTEMI）患者梗死相关动脉及病情严重程度中的临床价值。 方法 回顾性分析医院2016年6月~2020年6月126例NSTEMI患者的影像学资料，其均进行2DE及冠状动脉造影（CAG）检查。将CAG检查提示至少1支动脉狭窄程度 > 50%的124例患者作为研究对象，统计其2DE检查中是否出现左室壁节段运动异常（RWMA），比较RWMA者与未出现RWMA者动脉病变特点；将86例2DE检查提示RWMA的患者作为研究对象，以其CAG诊断梗死相关动脉作为“金标准”，分析2DE在确认梗死相关动脉中的应用价值；以Killip分级作为AHF患者病情严重的划分标准，比较不同分级患者2DE检查中动脉壁内膜中膜厚度。 结果 124例患者中2DE检查中出现RWMA的患者共85例，未出现RWMA的患者共39例，两组单支病变、双支病变及多支病变占比的差异均有统计学意义（P < 0.05）；2DE检查出现RWMA的患者共86例，86例患者中均可通过CAG准确判断梗死相关动脉，其中左前降枝动脉者26例，右冠状动脉者40例，左回旋支者20例，以CAG为“金标准”，经RWMA推测梗死相关动脉的准确率为95.35%；Killip分级Ⅰ~Ⅱ级的轻度组患者内膜中膜厚度显著低于Ⅲ~Ⅳ级患者（P < 0.05）。 结论 借助2DE可有效判断NSTEMI患者病情严重程度，确认梗死相关动脉，在指导临床调整治疗方案，判断患者病情中具有良好的价值。 -
关键词:
- 超声心动图 /
- 颈动脉内中膜厚度 /
- 非ST抬高型心肌梗死 /
- 冠脉病变支数 /
- 冠脉狭窄程度
Abstract:Objective To investigate the clinical value of two-dimensional echocardiography (2DE) in evaluating the severity of non-ST-segment elevation myocardial infarction (NSTEMI) in the elderly. Methods The image data of 126 elderly patients with NSTEMI in our hospital from June 2016 to June 2020 were respectively analyzed. All patients received 2DE and coronary arteriography (CAG). CAG examination showed that 124 patients had at least one main coronary artery and/or branch with diameter stenosis > 50%, then 2DE was used to detect the regional wall motion abnormality (RWMA) among those patients. The characteristics of arterial lesions was compared between RWMA and non-RWMA patients. The 2DE examination indicated that 86 of 126 patients had RWMA, meantime, the value of 2DE in identifying infarct related artery was analyzed using CAG as "gold standard". Killip grading was used as a criterion for the classification of severity of acute myocardial infarction patients, and the intima media thickness of middle artery wall in 2DE examination of patients with different grades was compared. Results Among the 124 patients, 2DE examination showed that 85 patients had RWMA and 39 patients had no RWMA. The proportions of single-vessel lesions, double-vessel lesions and multivessel lesions showed significant difference between RWMA and non-RWMA patients (P < 0.05). CAG accurately identified the infarct- related arteries of 86 patients, and the lesions were found at left anterior descending artery in 26 cases, right coronary artery in 40 cases, and left circumflex in 20 cases. CAG results indicated that the accuracy of RWMA in predicting infarct-associated arteries was 95.35%. The intima media thickness of patients of Killip grade Ⅰ-Ⅱ was significantly lower than that of Ⅲ-Ⅳ patients (P < 0.05). Conclusion Application of 2DE can effectively judge the severity of elderly patients with NSTEMI and locate the infarct-related arteries. -
表 1 RWMA及NRWMA患者冠脉病变特点分析
Table 1. Analysis of coronary artery lesions in RWMA and nrwma patients [n (%)]
组别 单支病变 双支病变 多支病变 RMWA（n=85） 10（11.76） 20（23.53） 55（64.71） NRMWA（n=39） 12（30.77） 17（43.59） 10（25.64） χ2 14.059 9.314 20.106 P < 0.001 0.002 < 0.001 RWMA: 左室壁节段运动异常; NRWMA: 未出现左室壁节段运动异常. 
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表 2 根据RWMA推测梗死相关动脉的准确性
Table 2. Accuracy of predicting infarct related artery based on RWMA (n)
诊断方式 梗死相关动脉 合计 LAD RCA LCX CAG诊断 26 40 20 86 2DE推测 26 37 19 82 符合率（%） 100.00 92.50 95.00 95.35 CAG: 冠状动脉造影; 2DE: 超声心动图; LAD: 左前降支; RCA: 右冠状动脉; LCX: 左回旋支.
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