Clinical Study Of Assessment Of Cardiac Function And Long-Term Prognosis In Patients With Acute Myocardial Infarction After Percutaneous Intervention By Contrast Echocardiography

BackgroundThe morbidity and mortality of acute myocardial infarction(AMI)show an upward trend,which is an important cause of death in patients with coronary heart disease.Early evaluation of myocardial microcirculation,microcirculatory flow reserve and myocardial function in patients with AMI is the key to ensure the best treatment.At present,the independent effect of abnormal microvascular perfusion(MVP)on the prognosis of patients with AMI after PCI is not clear.The prognostic value of myocardial contrast echocardiography(MCE)in AMI needs to be further discussed.ObjectiveMCE was used to evaluate wall motion and myocardial circulatory perfusion in patients with acute myocardial infarction,and to predict long-term clinical prognosis according to myocardial circulatory perfusion grouping.Methods1.The MCE images of 17 patients with AMI after PCI were analyzed,and the ventricular wall motion and myocardial perfusion were observed to evaluate the clinical diagnostic value.2.According to the perfusion type of MCE microcirculation,117 patients were divided into three groups:normal microvascular perfusion(nMVP)group,microvascular slow flow(dMVP)group and microvascular occlusion(MVO)group.The patients were followed up by telephone,the LVEF of the patients was followed up,the clinical endpoint events of the patients were counted,and the factors affecting the endpoint events were analyzed by COX regression to explore the prognostic value of MCE in AMI.The main end events were cardiovascular death and all-cause death,and the secondary end events were re-hospitalization of angina pectoris.Results1.The LVEF values of 1.117 patients measured by TTE and MCE were(59.5±8.3)%and(58.1±9.0)%respectively,the difference was not statistically significant(P=0.080).There were 301 segments with abnormal left ventricular wall motion observed by MCE,and the WMSI value was 1.17±0.18.there were 261 segments with abnormal myocardial perfusion,and the MPSI value was 1.19±0.21.There was a negative correlation between the WMSI and MPSI measured by MCE and the LVEF measured by the corresponding TTE(r=0.446,P<0.01,P<0.01).2.A total of 48 patients were followed up with LVEF.The results showed that there was no significant change in LVEF in nMVP and MVO groups,but LVEF was significantly improved in dMVP group.There were 30 patients in nMVP group,44 patients in dMVP group and 39 patients in MVO group.The median follow-up time was 473 days.COX multivariate regression analysis showed that MCE myocardial perfusion group(HR=1.771,0.034,95%CI:1.043-3.006),TG(HR=1.010,P=0.017,95%CI:1.002-1.018).As an important predictor of compound end point,survival curve showed that there were differences in the incidence of compound end point events among nMVP,dMVP and MVO groups(P<0.05).CONCLUSION1.MCE is safe in clinical application in patients with AMI and has important diagnostic value.It can observe whether patients have abnormal wall motion and myocardial perfusion,and has certain advantages in observing apical thrombus and ventricular aneurysm.2.The decrease or deletion of MVP after successful PCI treatment of AMI is common,and the timely recovery of revascularization when MVP decreases can save cardiac function.Myocardial microcirculation is a significant predictor of clinical end events in patients with AMI,and patients with poor myocardial perfusion are more likely to have clinical end events.