2024 年第 6 期 第 0 卷

左心房应变与左心室射血分数轻度降低或保留的ST段抬高型心肌梗死患者血清N末端B型脑钠肽前体水平的相关性研究

Relationship between left atrial strain and N-terminal pro-brain natriuretic peptide level in ST-segment elevation myocardial infarction patients with mildly reduced or preserved left ventricular ejection fraction

作者：吕赛梅迎晨韩蕊马旃王继红赵兴山雷海玲刘巍

英文作者：Lyu Sai Mei Yingchen Han Rui Ma Zhan Wang Jihong Zhao Xingshan Lei Hailing Liu Wei

单位：首都医科大学附属北京积水潭医院心内科北京大学第四临床医学院，北京100035

英文单位：Department of Cardiology Beijing Jishuitan Hospital Capital Medical University Fourth School of Clinical Medicine of Peking University Beijing 100035 China

关键词：急性ST段抬高型心肌梗死；经皮冠状动脉介入；左心房应变；N末端B型脑钠肽前体

英文关键词：AcuteST-segmentelevationmyocardialinfarction;Percutaneouscoronaryintervention;Leftatrialstrain;N-terminalpro-brainnatriureticpeptide

• 摘要：

• 目的 探讨左心房应变与左心室射血分数（LVEF）轻度降低或保留的ST段抬高型心肌梗死（STEMI）患者血清N末端B型脑钠肽前体（NT-proBNP）水平的相关性。方法 入选2022年3—12月于首都医科大学附属北京积水潭医院心内科首次诊断急性STEMI并在24 h内行经皮冠状动脉介入（PCI）治疗，急性期LVEF＞40%的患者。应用二维斑点追踪技术分析患者的左心房应变参数。根据左心房储存期纵向应变（LASr）数值将患者分为LASr减低组和LASr正常组。比较2组患者临床资料及超声资料。采用多元线性回归模型分析LASr与LVEF轻度降低或保留的STEMI患者血清NT-proBNP峰值的关系。结果 51例接受PCI治疗且急性期LVEF＞40%的急性STEMI患者中，LASr减低组22例（43.1%），LASr正常组29例（56.9%）。LASr减低组年龄、NT-proBNP峰值均高于LASr正常组［（60±12）岁比（50±12）岁、1 679.0(811.4,2 133.2)ng/L比584.2(201.5,1 524.0)ng/L］，差异均有统计学意义（均P＜0.05）。LASr减低组左心房通道期纵向应变、左心房收缩期应变高于LASr正常组，差异均有统计学意义（均P＜0.05）。多元线性回归模型分析结果表明，校正前壁心肌梗死、肌酸激酶同工酶峰值、LVEF后，LASr是LVEF轻度降低或保留的STEMI患者血清NT-proBNP峰值的独立影响因素（P=0.039）。结论 LASr是LVEF轻度降低或保留的STEMI患者PCI治疗围手术期NT-proBNP峰值的独立影响因素。

• Objective To investigate the relationship between left atrial strain and N-terminal pro-brain natriuretic peptide (NT-proBNP) level in ST-segment elevation myocardial infarction (STEMI) patients with mildly reduced or preserved left ventricular ejection fraction （LVEF）. Methods Patients who were first diagnosed with acute STEMI and underwent percutaneous coronary intervention (PCI) within 24 h from March to December 2022 in Department of Cardiology, Beijing Jishuitan Hospital, Capital Medical University, with LVEF > 40% in the acute phase, were enrolled. The left atrial strain parameters were analyzed by two-dimensional speckle tracking imaging. According to the value of left atrial strain during reservoir phase (LASr), patients were divided into reduced LASr group and normal LASr group. The clinical data and ultrasound data of the two groups were compared. Multiple linear regression model was used to analyze the relationship between LASr and serum NT-proBNP peak value in STEMI patients with mildly reduced or preserved LVEF. Results Among 51 patients with acute STEMI and LVEF >40% who underwent PCI, there were 22 cases (43.1%) in reduced LASr group and 29 cases (56.9%) in normal LASr group. Age and NT-proBNP peak value in the reduced LASr group were higher than those in the normal LASr group［(60±12)years vs (50±12)years, 1 679.0(811.4,2 133.2)ng/L vs 584.2(201.5,1 524.0)ng/L］(both P＜0.05). The longitudinal strain during left atrial channel phase and strain during left atrial systolic phase in the reduced LASr group were higher than those in the normal LASr group (both P＜0.05). Multiple linear regression analysis showed that after adjusting for anterior myocardial infarction, peak value of creatine kinase isoenzyme and LVEF, LASr was an independent predictor of serum NT-proBNP peak value in STEMI patients with mildly reduced or preserved LVEF (P=0.039). Conclusion LASr is an independent predictor of NT-proBNP peak value in STEMI patients with mildly reduced or preserved LVEF undergoing PCI.