| Objective: 1.To explore whether it had a related relationship between the left atrial volume and strain parameters of patients and the occurrence of major adverse cardiac events(MACE events)in people who had AMI,and to provide ultrasound reference indicators for the prognosis of AMI patients.2.Discuss the practical value of twodimensional speckle tracking technology(2D-STI)for assessing left atrial function in patients with acute myocardial infarction(AMI).Methods: In the experiment,two-dimensional ultrasound,M-mode ultrasound,and2D-STI ultrasound were performed on 70 patients diagnosed with acute myocardial infarction in Taizhou People’s Hospital from January 2020 to September 2020,and the subjects were followed up for 5 months for major adverse cardiac events(MACE events).According to the left atrial volume index(LAVI),these candidates were enrolled in group A(LAVI≥30ml/m~2,34 cases)and group B(LAVI<30ml/m~2,36 cases).Another 36 healthy finalits were brought into the control group(group C).1.Measure the conventional cardiac parameters related to the measured values of left heart parameters in groups A,B,and C: Two-dimensional ultrasound and M-mode ultrasound examinations were operated on all those finalits to measure their the left atrial end-systolic diameter(LAd)and the left ventricular ejection fraction(LVEF).Among them,LAd was measured on the long axis view of the left ventricle next to the sternum,and LVEF was measured by the two-plane Simpson method.2.2D-STI technology was used to measure the volume related parameters of groups A,B and C: Use 2D-STI software technology to measure the left atrial maximal volume(LAVmax),the left atrial minimal volume(LAVmin)and the left atrial pre-systolic volume(LAVp).Then work out the left atrial total ejection fraction(LATEF)and the left atrial passive ejection fraction(LAPEF),the left atrial active ejection fraction(LAAEF)and the left atrial volume index(LAVI)by referring to the formula given.3.2D-STI technology was used to measure the strain related parameters of groups A,B and C: Use 2D-STI software tools to analyze the dynamic image data of each section of the left ventricular apex position,measure and calculate the mean systolic peak strain rate of the left atrium(mSRs)and the mean early diastolic peak strain rate of the left atrium(mSRe),the mean late diastolic peak strain rate of the left atrium(mSRa)and the mean systolic peak strain of the left atrium(mSs).4.MACE events follow-up:Five months after leaving the hospital,the above subjects were followed up through outpatient clinics,re-hospitalization and telephone,and recorded whether they had one of the MACE events.Results:1.Comparison of basic information: The gender,height,weight,body surface area(BSA),heart rate and other biometric somatosexual details of the finalists in groups A,B,and C were included in the comparison,and it did not have statistical discrepancy enormously between the three groups(all P > 0.05).When comparing biometric somatosexual detail such as the age of the finalists,the analysis results demonstrated that the average age of selected candidates in group A was enormously older than that of the two groups B and C(P<0.01),however it did not have statistical discrepancy enormously in the average age of finalists between group B and group C(P>0.05).2.Comparison of the mean values of routine ultrasound examination parameters of patients in groups A,B and C: Compared with group C,the average values of LAd in groups A and B were enormously increased,and the average values of LVEF were enormously decreased in the two groups A and B,and those transformations were more dramatic in group A,it had statistical discrepancy enormously in those messages above(all P<0.05).3.Contrast of the average of the volume indicators in groups A,B,and C calculated by 2D-STI technology:Compared with group C,the average values of LAVmin and LAVp of groups A and B were significantly increased,and the average values of LATEF and LAPEF were reduced,and the transformations were more dramatic in group A.(all P<0.05).Compared with group C,the mean value of LAVmax and the mean value of LAVI of group A were slightly increased,and the mean value of LAAEF was slightly reduced,and the differences had dramatic statistical characteristics.(all P < 0.05).However,when we compared the mean value of LAVmax,the mean value of LAVI,and the mean value of LAAEF those in the two groups B and C,it demonstrated that those discrepancies were not dramatic in statistics(all P>0.05).4.Analysis and comparison of the strain parameters and their absolute values measured by 2D-STI technology: Compared with group C,the absolute values of mSRs,mSRe,and mSs were lower in the two groups A and B,and those transformations were more dramatic in group A,and it had statistical discrepancy enormously in those messages above(all P<0.05).Compared with group C,the absolute value of mSRa was lower enormously in group A(P<0.05).However,when the absolute value of mSRa between the two groups B and C was compared,it did not have statistical discrepancy enormously in the message(P>0.05).5.The correlation between LAVI and left atrial volume and strain parameters: LAVI was significantly related to parameters such as patient age,LAd,mSRs,mSRe,mSRa,mSs and LVEF.Among them,age and LAd were positively correlated,mSRs,mSRe,mSRa,mSs,and LVEF were negatively correlated.The differences were statistically significant(all P<0.01).6.The correlation between the occurrence of MACE events and various typica parameters: During the 5-month clinical follow-up observation period,the proportion of patients in group B that had typical MACE events within this time limit was significantly lower than that in group A(58.82% in group A and 27.78% in group B),and it had statistical discrepancy enormously in this connection(P<0.05).Single-factor Logistic regression statistical analysis demonstrated that those principal factors correlated to the frequency of all kinds of MACE events were the indicators such as age,LAd,LVEF,mSRa and LAVI.(all P<0.05),and the most significant factors were the absolute value of mSRa and the LAVI value(all P<0.01).The ROC curve method was used to evaluate the predictive value,and it was found that the absolute value of mSRa predicted the AUC of MACE event was 0.73,and the best cutoff value was 2.17(1/s).Conclusion:1.Two-dimensional ultrasound combined with 2D-STI can detect the changes of left atrial function in patients with AMI.LAVI≥30ml/m2 and absolute value of mSRa<2.17(1/s)are powerful predictors of MACE events in acute myocardial infarction patients.The smaller the absolute value of mSRa and the larger the LAVI were,the often more serious the left atrial remodeling was,the higher the risk of MACE events was and the worse the prognosis was.In terms of disease diagnosis and treatment,effective combination of different but interrelated factors can reduce errors and misjudgments.The combination of left atrial volume and strain parameters can make them complement each other,which can better predict the adverse prognosis of patients with AMI.2.2D-STI can evaluate the changes in the strain capacity of the left atrium in patients with AMI,and provides an important evaluation method for judging the early left atrial dysfunction and desynchronization motion in AMI patients. |
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