关键词: 左心声学造影, 三维超声全自动定量技术, 冠心病, 经皮冠状动脉介入, 心血管不良事件, 危险因素, 预测价值

Abstract:

Objective To explore the value of left ventricular contrast echocardiography and three-dimensional echocardiography Heart Model （3D-HM） parameters in predicting major adverse cardiovascular events （MACE） in patients with coronary heart disease after percutaneous coronary intervention （PCI）. Methods A total of 197 patients with coronary heart disease， diagnosed by coronary angiography and treated with PCI in the Department of Cardiology of the First Hospital of Changsha from June 2023 to December 2024， were selected. Meanwhile， 104 healthy volunteers during the same period were also recruited. The general data， 3D-HM parameters ［left ventricular end-diastolic volume （LVEDV）， left ventricular end-systolic volume （LVESV）， left ventricular ejection fraction （LVEF）］， and myocardial contrast echocardiography （MCE） parameters ［platform peak intensity （A）， curve slope （β）， myocardial blood flow （A × β）， perfusion score index （PSI）］ at the time of admission were compared between the two groups. All patients were followed up for 6 months after PCI. The occurrence of MACE after PCI in patients with coronary heart disease was recorded. Subsequently， the patients were divided into the MACE group （26 cases） and the non-MACE group （171 cases）. The general data， 3D-HM parameters， and MCE parameters before PCI and at 1 week， 3 months， and 6 months after PCI were compared between the two groups of patients. The risk factors for the occurrence of MACE after PCI in patients with coronary heart disease and the predictive value of left ventricular contrast echocardiography and 3D-HM parameters for MACE after PCI in patients with coronary heart disease were evaluated by multivariate logistic regression analysis and receiver operating characteristic curve （ROC）， respectively. Results Compared with healthy volunteers， the left ventricular end-diastolic volume （LVEDV）， left ventricular end-systolic volume （LVESV）， and pressure-strain index （PSI） of patients with coronary heart disease were higher， whereas the left ventricular ejection fraction （LVEF）， A， β， and A × β were lower （P < 0.05）. The proportion of patients with fewer than 4 viable myocardial segments in the major adverse cardiovascular event （MACE） group was higher than that in the non-MACE group （P < 0.05）. When compared with the same group before surgery， in the two groups of patients with coronary heart disease， the LVEDV， LVESV， and PSI at 1 week， 3 months， and 6 months after surgery gradually decreased， reaching the lowest levels at 6 months after surgery. Meanwhile， the LVEF， A， β， and A × β gradually increased， reaching the highest levels at 6 months after surgery （P < 0.05）. Compared with the non-MACE group， the LVEDV， LVESV， and PSI of patients in the MACE group were higher at 1 week， 3 months， and 6 months after surgery， while the LVEF， A， β， and A × β were lower （P < 0.05）. Multivariate analysis indicated that a high level of PSI at 1 week after percutaneous coronary intervention （PCI） （OR = 2.351） was a risk factor for MACE in patients with coronary heart disease after PCI. In contrast， high levels of LVEF （OR = 0.381）， A （OR = 0.500）， β （OR = 0.521）， and A × β （OR = 0.538） at 1 week after PCI were protective factors （P < 0.05）. The results of receiver operating characteristic （ROC） analysis demonstrated that the area under the curve （AUC） of the combination of LVEF， A， β， A × β， and PSI in predicting MACE in patients with coronary heart disease after PCI was 0.891， which was greater than that of LVEF （0.647）， A （0.697）， β （0.676）， A × β （0.681）， or PSI （0.709） （P < 0.05）. Conclusions Left ventricular contrast echocardiography and 3D-HM parameters （LVEF， A， β， A × β， PSI） are strongly associated with the occurrence of major adverse cardiovascular events （MACE） after percutaneous coronary intervention （PCI） in patients with coronary heart disease. The combination of left ventricular contrast echocardiography and 3D-HM parameters exhibits high predictive efficiency for the clinical prognosis of these patients.

Key words: left ventricular contrast echocardiography, three-dimensional echocardiography heart model, coronary heart disease, percutaneous coronary intervention, major adverse cardiovascular events, risk factors, predictive value