| Background and purpose:Heart failure is a serious or terminal manifestation of various heart diseases.It is one of the two major cardiovascular epidemics in the 21 st century.At present,coronary heart disease has become the main cause of heart failure.With the advent of new drugs,great progress has been made in the drug treatment of heart failure.However,the effect of drug treatment alone is not good,the quality of life and prognosis of patients with severe heart failure of coronary heart disease are poor,and the mortality rate is high.Besides the formation of scar tissue after infarction,severe ischemia leads to myocardial hibernation and myocardial stunning,which is also an important reason for the decrease of myocardial contractility and the development of heart failure.Therefore,revascularization is an important way to improve coronary heart disease and heart failure.Studies have shown that the effect of revascularization in coronary heart disease with heart failure is mainly related to the number of myocardial viability.Preoperative evaluation of myocardial viability is very important.At present,the main evaluation methods of myocardial viability are positron emission tomography(PET),single photon emission computed tomography(SPECT),myocardial contrast echocardiography(MCE)and myocardial magnetic resonance imaging(CMR).Because of the existing conditions,costs,complexity of operation and tolerance of patients with heart failure,these methods are used as routine evaluation hands before revascularization.Duan still has some difficulties.Therefore,it is of practical significance to explore a simple clinical assessment index of myocardial viability and its predictive value for the effect of revascularization.In this study,we observed the changes of ECG dynamic ischemia before operation and the effect of percutaneous coronary intervention(PCI)in patients with coronary heart disease and heart failure,and analyzed the predictive value of ECG dynamic ischemia changes on the effect of PCI.Research methods:From September 2005 to February 2018,73 patients with heart failure with reduced ejection fraction(HFr EF)were admitted to the 967 Hospital of the PLA Joint Logistics Support Force(formerly the 210 Hospital of the PLA)and received PCI.The patients were divided into two groups according to whether there were dynamic ischemic changes in ECG before operation.Group A(with dynamic changes in ECG,n = 44)and Group B(without dynamic changes in ECG,n = 29).The baseline data of the two groups were recorded,including average hospitalization days,NYHA cardiac function classification at 1 week after operation,N-terminal B-type natriuretic peptide precursor(NT-pro BNP),left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),and major cardiovascular events(MACE)within 12 months after operation,including all-cause death,myocardial infarction and re-hospitalization rate of heart failure.Statistical analysis was made on the recorded data.Result:1.Comparison of baseline data between the two groupsComparison of baseline data between the two groups: general clinical data [age(years)(71.45 ± 8.88 vs 70.14 ± 9.91,P = 0.556),gender(male ratio,%)(70.5% vs 82.7%,P=0.239),NT-pro BNP(pg/ml)(3602.73±7493.20vs2254.14±2747.17,P=0.357),LVEF(%)(34.73±4.94vs35.59±3.21,P=0.411),LVEDD(mm)(67.41±5.98vs64).90±5.13,P=0.068),NYHA class II(%)(20.45% vs 24.14%,P=0.577),NYHA class III(%)(31.82% vs31.03%,P=0.778),NYHA IV Grade(%)(45.45% vs 44.83%,P = 0.958),length of hospital stay(days)(7.83 ± 1.52 vs 7.16 ± 1.53,P = 0.072),history of myocardial infarction(%)(81.82% vs 75.86%),P = 0.544),arrhythmia [atrial fibrillation(%)(34.09% vs 27.59%,P = 0.613),ventricular arrhythmia(%)(61.36% vs 55.17%,P =0.577)],hypertension(%)(70.45% vs 68.97%,P=0.778),diabetes(%)(61.36% vs86.21%,P=0.661),hyperlipidemia(%)(68.18% vs 62.07%,P= 0.514),smoking(%)(45.45% vs 34.48%,P=0.358),body mass index(BMI)(23.44±3.80 vs 23.98±3.8 0,P=0.555),renal insufficiency(%)(18.18% vs 27.59%,P=0.349),history of peripheral vascular disease(%)(4.55% vs 3.45%,P=0.820)],medication [ Antiplatelet drugs(95.45% vs 96.56%,P=0.806),lipid-lowering drugs(86.36% vs 86.21%%,P=0.506),β-blockers(93.18% vs 93.10%,P= 0.688),ACER/ARB(77.27% vs 82.76%,P=0.703),LCZ696(13.64% vs 10.34%,P=0.867),Evadis(11.36% vs 6.90%,P=0.722),MRA(86.36% vs 82.75%,P=0.506),cedilan/digoxigenin(72.73% vs 72.41%,P=0.852),vasodilator(61.36% vs 58.62%,P=0.726)],coronary lesions [2 lesions(4.55% vs3.45%,P = 0.348),3 lesions(95.45% vs 96.55%,P = 0.348),CTO lesions(40.91% vs34.48%,P =0.669),LAD lesions(92.73% vs 96.55%,P=0.083)],revascularization[full revascularization(6.98% vs 3.45%,P=0.688)anterior descending(79.54% vs62.07)%,P=0.070),right coronary artery(25.00% vs 34.48%,P=0.304),gyroscopic branch(34.09% vs 24.14%,P=0.448)],the above baseline data were not statistically significant.(P value> 0.05).2.Comparison of secondary endpoints between the two groups2.1 NYHA classification changes and hospitalization time 1 week after operationThere were 19 cases in group A,20 cases in group B(43.18% vs 68.97%,P <0.05),25 cases in group A and 9 cases in group B(56.82% vs 31.03%,P = 0.039),and there was no change or decrease in NYHA grade in both groups.One week after PCI,NYHA cardiac function in group A was significantly improved compared with that in group B(P < 0.05).The average hospitalization days in group A were 6.86 + 1.70(days),9.97 + 1.12(days)in group B,and the average hospitalization days in group A were shorter than those in group B.There was significant difference in hospitalization time between the two groups(P < 0.05).2.2 Postoperative decrease of NT-proBNP in two groupsThe NT-pro BNP value of the two groups increased by a percentage(44.30+6.89vs31.86+4.46,P<0.05)one week after operation,one month after operation(63.17+7.87vs55.05+7.28,P<0.05),three months after operation(72.07+7.20vs66.17+5.50,P<0.05),six months after operation(80.03+5.85vs73.61+6.85,P<0.05),and 12 months after operation(86.15+5.11vs80.65+5.49,P<0.05).NT-pro BNP decreased in both groups after operation,and decreased significantly in group A compared with group B in 1 week,1month,3 months,6 months and 12 months after operation(P < 0.05).2.3 Changes in LVEF values between the two groups after operationLVEF(35.57+4.69%vs36.14[(36.14+3.143.42%,P=0.575,P=0.575,P=0.575,P=0.575,(39.57 +4.49% vs 38.44.57 [4.49% vs 38.49 [(39.57 [3.49%,P=0.149,P=0.149,P=09,(44.09 [4.90% vs40.90% vs 40.03 [0.03 [3.03 [3.49%%%P < 0.05,P < 0.05,P<0.05),LVEF(46.61 +5.61 [(2)The results of the study are as follows:1)The results of the study are as follows:1)The results of the study are as follows:1)The results of the study are as follows:1.There was no significant difference in LVEF between the two groups at 1 week and 1 month after operation(P > 0.05).The value of LVEF in group A increased significantly compared with group B at 3,6 and 12 months after operation(P < 0.05).2.4 Changes in LVEDD values between the two groups after operationLVEDD(mm)(67.82 +5.03 vs 66.97 +6.97 +4.29,P = 0.455,P = 0.455,P = 0.29,P = 0 455,P = 0 455,1 month LVEDD(mm)(64.66 [5.43 vs 64.66 [5.43v64.97+64.97(P = 0.798),3 months LVEDD(mm(59.80 [5 5.80 [5.25 vs63.34 [[[3 P=4.27,P = 0 0.003,P = 0 3),6 months,6 months LVEDD 4.47,P < 0.05).There was no significant difference in the value of LVEDD between the two groups at 1 week and 1month after operation(P > 0.05).The value of LVEDD in group A was significantly lower than that in group B at 3 months,6 months and 12 months after operation(P <0.05).3.Comparison of primary endpoint events between the two groupsThe endpoint event mainly refers to the MACE event within 12 months,including mortality,myocardial infarction,heart failure and hospitalization rate.The two groups were followed up for 12 months mortality(6.98% vs 6.90%,P=0.990),myocardial infarction(4.65% vs 3.45%,P=0.806),and rehospitalization rate(18.18% vs 41.38%,P=0.017).).There was no significant difference in mortality and myocardial infarction between the two groups(P>0.05).The re-hospitalization rate of heart failure in group A was lower than that in group B,and the difference was statistically significant(P<0.05).Conclusion:Preoperative dynamic ischemia of ECG is the direct evidence of myocardial viability.Patients benefit more from PCI,which may be a reliable index for predicting the effect of PCI in patients with heart failure. |
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