Myocardial Contrast Echocardiography For Evaluation Of Coronary Microcirculation Disturbance After PCI In Patients With Acute Myocardial :application And Influencing Factors

Objective: To evaluate coronary microcirculation disorder(CMD)after percutaneous coronary intervention(PCI)in patients with acute myocardial infarction(AMI)using myocardial contrast echocardiography(MCE)and analyze the influencing factors of CMD.Method: 83 patients with AMI who underwent PCI at the First Affiliated Hospital of Dali University from September 2020 to October 2022 were included in the study.Transthoracic echocardiography(TTE)and MCE were routinely performed after surgery.According to the results of MCE,they were divided into CMD group and non CMD group.General clinical data,surgical related data,TTE,and MCE data of the two groups were collected,and multivariate binary logistic regression analysis of independent predictors of CMD was performed,Compare the quantitative data of MCE and calculate the ROC curve,and conduct Spearman correlation analysis of myocardial perfusion score index(MPSI).Results:(1)The incidence of CMD in patients with AMI was approximately 62.7%.The level of brain natriuretic peptide(BNP)in the CMD group was significantly higher than that in non CMD patients [251(80447)ng/L vs.113(69246)ng/L](p=0.033).There was no significant difference between the two groups in gender,age,body mass index(BMI),smoking history,ST segment elevation myocardial infarction(STEMI),hypertension,diabetes,old myocardial infarction,serum D-dimer(D-D),serum C-reactive protein(CRP),serum low-density lipoprotein(LDL-C),serum triglyceride(TG),and serum creatinine(Scr)concentrations(p>0.05).(2)Compared with non CMD patients,the CMD group had a higher proportion of culprit vessels with left anterior descending branch(LAD)[36(69.2%)vs 11(35.5%),p=0.002],a higher preoperative Gensini score[76.47±33.73 vs 58.90±29.45,p=0.019]and no significant difference in the total number of diseased vessels(p>0.05).(3)Postoperative TTE results showed that there was no significant difference between the two groups in left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left atrial anteroposterior diameter(LAAP),diastolic function indicators such as early diastolic peak velocity(E),late diastolic peak velocity(A),E/A ratio,early diastolic motor velocity(e)/late diastolic motor velocity(a),and e/a ratio(p>0.05).(4)The results of postoperative MCE examination showed that compared with the non CMD group,the left ventricular ejection fraction(LVEF)in the CMD group significantly decreased [52.19 ± 12.99 vs 62.52 ± 10.49,p<0.001],the incidence of segmental wall motion abnormality(RWMA)significantly increased[46(88.4%)vs 9(29%),p<0.001],and the ventricular wall motion score(WMSI)significantly decreased [1.34 ± 0.24 vs 1.10 ± 0.26,p<0.001],The incidence of ventricular aneurysm was significantly increased [11(21.2%)vs 0(0%),p=0.006],while there was no significant difference in the incidence of left ventricular thrombosis(p>0.05).(5)Logistic regression analysis showed that LVEF,WMSI,and criminal vascular distribution were independent risk factors for CMD in patients with AMI after PCI.The area under the ROC curve(AUC)of LVEF and WMSI were 0.738 and 0.838,respectively,with sensitivity of 0.71 and 0.865,and specificity of 0.731 and 0.774,respectively.(6)Quantitative analysis of MCE showed that A、β、Axβ The values were all smaller than those in the non CMD group,with statistically significant differences(p<0.001).The ROC curves of the quantitative analysis indicators of MCE in the two groups of patients showed that the A value of the diagnostic CMD in this studyβ Value and A × β The AUC values were 0.843,0.840,and 0.913,respectively,with sensitivity of 0.769,0.615,and 0.808,and specificity of 0.871,0.968,and 0.968,respectively.(7)Spearman correlation analysis showed that WMSI,Gensini scores were positively correlated with MPSI,and the correlation between WMSI(r=0.516,p<0.001)and MPSI was stronger than Gensini scores(r=0.442,p<0.001);LVEF was negatively correlated with MPSI(r=-0.471,p<0.001).Conclusion: The detection rate of CMD in AMI patients after PCI was higher by MCE.CMD patients had higher degree of coronary stenosis,lower left ventricular systolic function,and were more likely to have segmental wall motion abnormalities.LAD lesions,WMSI and LVEF were independent risk factors for CMD,and quantitative analysis of MCE was also a useful indicator for evaluating CMD.WMSI and Gensini scores were positively correlated with myocardial perfusion,while LVEF was negatively correlated with myocardial perfusion,which could be used as one of the important indicators for evaluating myocardial perfusion after PCI.