基于左心声学造影及三维超声全自动定量技术参数预测冠心病患者经皮冠状动脉介入术后心血管不良事件的价值

doi:10.3969/j.issn.1006-5725.2026.01.014

Abstract

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

CLC Number:

R540.45

Zhouzhan LUO,Qingling HU,Qiaofeng WANG,Guolong LEI,Mengyao TANG,Chao PENG,Yingying TANG. Value of left ventricular contrast echocardiography and three-dimensional echocardiography heart model parameters on predicting major adverse cardiovascular events in patients with coronary heart disease after percutaneous coronary intervention[J]. The Journal of Practical Medicine, 2026, 42(1): 110-118.

Figures/Tables 7

Tab.1

Tab.2

Comparison of baseline data between the two groups of patients"

指标	发生MACE组（n = 26）	未发生MACE组（n = 171）	χ²/t值	P值
性别/［例（%）］			0.061	0.805
男	15（57.69）	103（60.23）
女	11（42.31）	68（39.77）
年龄/岁	62.07 ± 10.17	59.18 ± 10.03	1.366	0.173
体质量指数/（kg/m2）	22.94 ± 1.75	22.61 ± 1.82	0.866	0.388
发病至PCI时间/h	3.67 ± 0.32	3.58 ± 0.29	1.454	0.148
静息心率/（次/min）	76.05 ± 8.55	77.47 ± 8.61	0.784	0.434
脉压/mmHg	61.07 ± 10.36	62.19 ± 10.44	0.510	0.611
吸烟史/［例（%）］	12（46.15）	69（40.35）	0.314	0.575
饮酒史/［例（%）］	5（19.23）	39（22.81）	0.166	0.683
心血管疾病家族史/［例（%）］	15（57.69）	75（43.86）	1.740	0.187
高血压/［例（%）］	12（46.15）	60（35.09）	1.192	0.275
糖尿病/［例（%）］	11（42.31）	55（32.16）	1.042	0.307
高脂血症/［例（%）］	10（38.46）	40（23.39）	2.706	0.100
病变部位/［例（%）］			2.256	0.521
左主干	7（26.92）	52（30.41）
左前降支	6（23.08）	44（25.73）
左回旋支	6（23.08）	49（28.65）
右冠状动脉	7（26.92）	26（15.21）
病变支数/［例（%）］			1.651	0.438
1支	7（26.92）	63（36.84）
2支	8（30.77）	56（32.75）
> 2支	11（42.31）	52（30.41）
疾病临床分型/［例（%）］			0.508	0.776
稳定型心绞痛	8（30.77）	43（25.15）
不稳定型心绞痛	8（30.77）	63（36.84）
急性心肌梗死	10（38.46）	65（38.01）
存活心肌节段/［例（%）］			6.038	0.014
< 4个	17（65.38）	68（39.77）
≥ 4个	9（34.62）	103（60.23）
介入治疗门-球时间≥ 90 min/［例（%）］			1.803	0.179
是	11（42.31）	50（29.24）
否	15（57.69）	121（70.76）
支架置入数量/［例（%）］			1.063	0.303
≤ 2个	14（53.85）	110（64.33）
> 2个	12（46.15）	61（35.67）
TG/（mmol/L）	1.69 ± 0.50	1.54 ± 0.45	1.560	0.120
TC/（mmol/L）	4.41 ± 1.26	4.14 ± 1.18	1.077	0.283
LDL-C/（mmol/L）	2.27 ± 0.67	2.11 ± 0.64	1.180	0.239
HDL-C/（mmol/L）	1.20 ± 0.28	1.29 ± 0.37	1.189	0.236
HbA_lc/%	7.05 ± 2.03	6.43 ± 1.89	1.543	0.124
FBG/（mmol/L）	8.57 ± 2.47	7.89 ± 2.12	1.490	0.138
BNP/（ng/L）	110.58 ± 32.25	99.42 ± 29.51	1.775	0.078
cTnI/（μg/L）	0.77 ± 0.23	0.71 ± 0.21	1.340	0.182
CK-MB/（μg/L）	6.61 ± 1.85	6.17 ± 1.76	1.180	0.240
术后用药情况/［例（%）］
阿司匹林	21（80.77）	157（91.81）	3.159	0.076
P2Y₁₂抑制剂	21（80.77）	152（88.89）	1.391	0.238
β受体阻滞剂	20（76.92）	148（86.55）	1.666	0.197

Tab.2

Tab.3

Tab.4

Tab.5

Tab.6

Fig.1

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组别	例数	LVEDV/mL	LVESV/mL	LVEF/%	A/dB	Β/s^-1	A×β/（dB/s）	PSI
冠心病患者	197	136.57 ± 16.26	69.47 ± 8.21	49.13 ± 2.17	8.29 ± 1.85	1.22 ± 0.19	10.11 ± 1.87	1.84 ± 0.43
健康志愿者	104	107.05 ± 12.67	38.68 ± 5.95	63.87 ± 2.19	12.47 ± 2.09	1.74 ± 0.32	21.70 ± 4.46	1.21 ± 0.27
t值		16.108	33.831	55.863	17.813	17.671	31.620	13.588
P值		< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

组别	LVEDV/mL		LVESV/mL		LVEF/%
组别	发生MACE组（n = 26）	未发生MACE组（n = 171）	发生MACE组（n = 26）	未发生MACE组（n = 171）	发生MACE组（n = 26）	未发生MACE组（n = 171）
术前	141.97 ± 15.81	135.75 ± 16.22	72.08 ± 7.33	69.07 ± 8.28	47.23 ± 2.15	47.52 ± 2.18
术后1周	132.36 ± 14.30^a	123.45 ± 14.92^ad	65.34 ± 7.42^a	58.91 ± 6.82^ad	49.63 ± 3.22^a	51.28 ± 2.26^ad
术后3个月	125.85 ± 13.75^ab	116.64 ± 13.03^abd	57.47 ± 6.95^ab	48.27 ± 6.04^abd	52.33 ± 2.31^ab	56.62 ± 2.47^abd
术后6个月	118.51 ± 12.42^abc	110.93 ± 12.24^abcd	48.59 ± 6.30^abc	39.21 ± 5.17^abcd	55.06 ± 2.47^abc	59.65 ± 2.05^abcd
F_组间/P_组间	28.590/< 0.001		98.080/< 0.001		6.940/< 0.001
F_时间/P_时间	47.660/< 0.001		265.600/< 0.001		50.400/< 0.001
F_交互/P_交互	0.211/0.889		4.456/0.004		2.710/< 0.001

组别	A/dB		β/s^-1		A×β/（dB/s）		PSI
组别	发生MACE组（n = 26）	未发生MACE组（n = 171）	发生MACE组（n = 26）	未发生MACE组（n = 171）	发生MACE组（n = 26）	未发生MACE组（n = 171）	发生MACE组（n = 26）	未发生MACE组（n = 171）
术前	8.15 ± 1.86	8.31 ± 1.85	1.20 ± 0.18	1.22 ± 0.19	9.79 ± 1.94	10.16 ± 1.86	1.94 ± 0.42	1.82 ± 0.43
术后1周	8.94 ± 1.90^a	10.05 ± 1.96^ad	1.29 ± 0.19^a	1.43 ± 0.24^ad	11.53 ± 2.53^a	14.37 ± 2.61^ad	1.79 ± 0.32^a	1.61 ± 0.30^ad
术后3个月	10.02 ± 1.94^ab	11.36 ± 1.99^abd	1.43 ± 0.22^ab	1.59 ± 0.29^abd	14.33 ± 3.01^ab	18.06 ± 3.85^abd	1.58 ± 0.29^ab	1.40 ± 0.28^abd
术后6个月	11.05 ± 2.01^abc	12.42 ± 2.07^abcd	1.57 ± 0.28^abc	1.73 ± 0.31^abcd	17.35 ± 3.97^abc	21.49 ± 4.22^abcd	1.44 ± 0.27^abc	1.22 ± 0.25^abcd
F_组间/P_组间	23.170/< 0.001		19.170/< 0.001		66.150/< 0.001		26.430/< 0.001
F_时间/P_时间	53.590/< 0.001		49.310/< 0.001		143.300/< 0.001		49.890/< 0.001
F_交互/P_交互	1.892/0.129		1.551/0.200		6.152/0.001		0.367/0.777

变量	β	SE	Wald χ²	OR	95%CI	P值
高水平LVEDV	0.874	0.492	3.156	2.396	0.914 ~ 6.286	0.076
高水平LVESV	0.718	0.467	2.364	2.050	0.821 ~ 5.121	0.125
高水平LVEF	0.965	0.263	13.463	0.381	0.228 ~ 0.638	< 0.001
高水平A	-0.693	0.197	12.375	0.500	0.340 ~ 0.736	< 0.001
高水平β	-0.652	0.184	12.556	0.521	0.363 ~ 0.747	< 0.001
高水平A×β	-0.619	0.176	12.370	0.538	0.381 ~ 0.760	< 0.001
高水平PSI	0.855	0.236	13.125	2.351	1.481 ~ 3.734	< 0.001
存活心肌节段< 4个	1.051	0.577	3.318	2.861	0.923 ~ 8.863	0.069

指标	截点值	AUC	95%CI	P值	约登指数	敏感度/%	特异度/%
LVEF	49.05%	0.647	0.510 ~ 0.785	0.016	0.426	65.38	77.19
A	8.99 dB	0.697	0.567 ~ 0.827	0.001	0.464	69.23	77.19
β	1.32 s^-1	0.676	0.546 ~ 0.805	0.004	0.429	69.23	73.68
A×β	11.76 dB/s	0.681	0.556 ~ 0.807	0.003	0.364	61.54	74.85
PSI	1.75	0.709	0.599 ~ 0.819	0.001	0.414	65.38	76.02
联合		0.891	0.836 ~ 0.947	< 0.001	0.687	96.15	72.51

Value of left ventricular contrast echocardiography and three-dimensional echocardiography heart model parameters on predicting major adverse cardiovascular events in patients with coronary heart disease after percutaneous coronary intervention

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