WENG Wenchao,YANG Daoling,CHEN Jingwan. The value of two-dimensional speckle tracking imaging for predicting MACE in AMI patients one year after PCI[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2023, 53(1): 49-54.
Abstract：Objective: To evaluate two-dimensional ultrasound speckle tracking imaging (STI) in predicting major adverse cardiac events (MACE) for acute myocardial infarction (AMI) patients with one-year follow-up after percutaneous coronary intervention (PCI). Methods: From January 2019 to July 2021, 91 patients with AMI for PCI into Jinhua Municipal Central hospital were included in the study. They all received routine ultrasound and two-dimensional STI one week after surgery and were all followed up for 1 year, with MACE recorded (mainly including recurrent angina pectoris, recurrent myocardial infarction, new heart failure, malignant arrhythmia, rehospitalization and sudden cardiac death). Results: A total of 18 cases (19.78%, 18/91) with MACE were followed up, the time of MACE being 12-46 weeks after discharge, with median time of 37.5 weeks. Patients were divided into MACE group and non-MACE group, with no differences (P>0.05) found in gender, age, AMI type, PCI mode, target lesion stenosis rate, number and length of implanted stents, and postoperative medicine treatments. The left ventricular ejection fraction (LVEF) in MACE group was significantly lower and serum N-terminal pro-brain natriuretic peptide (pro-BNP) was significantly higher than that in non-MACE group (P<0.05); however, there were no differences in left ventricular end diastolic diameter and volume, end systolic diameter and volume, serum troponin I (cTnI) and creatine kinase isoenzyme (CK-MB) between the two groups (P>0.05). STI parameters including global longitudinal strain (GLS) and global circumferential strain (GCS) in MACE group were significantly higher than those in non-MACE group and global radial strain (GRS) was less too (P<0.05). Multivariate logistic regression model found that age≥70-years-old (OR=1.652, 95%CI=1.234-1.896, P=0.003), LVEF≤40% (OR=3.021, 95%CI=2.456-3.859, P<0.001), pro-BNP≥500 ng/mL (OR=2.235, 95%CI=1.652-3.002, P<0.001), GLS≥-22% (OR=1.958, 95%CI=1.452-2.639, P<0.001), GRS≤44% (OR=1.325, 95%CI= 1.084-1.996, P=0.005) and GCS≥-16% (OR=1.421, 95%CI=1.162-2.032, P=0.003) were all the independent risk factors of MACE. The receiver operating curve (ROC) showed that the area under the curve (AUC) of GLS, GRS and GCS for predicting MACE were 0.842, 0.803 and 0.756, respectively. Kaplan-Meier survival curve showed that the cumulative MACE incidence of patients with GLS≥-22% was significantly
higher than patients with GLS < -22%, patients with GRS≤44% was significantly higher than patients with GRS > 44%, and patients with GCS≥-16% was significantly higher than patients with GCS < -16% (P<0.05). Conclusion: In addition to the conventional indicators such as age, LVEF and pro-BNP, two-dimensional ultrasound STI parameters GLS, GRS and GCS is also of great value for predicting the occurrence of MACE for AMI patients one year after PCI.
