Association between the E-wave propagation index and left ventricular thrombus formation after ST-elevation myocardial infarction
Association between the E-wave propagation index and left ventricular thrombus formation after ST-elevation myocardial infarction
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DOI：
10.1016/j.ijcard.2020.10.078
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发表时间：
2021-02-08
影响因子：
3.5
通讯作者：
Olsen，Flemming Javier
中科院分区：
文献类型：
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作者：
Duus，Lisa Steen;Pedersen，Sune;Olsen，Flemming Javier
目的探讨作为心尖冲洗指标的e波传播指数（EPI）与st段抬高型心肌梗死（STEMI）患者左室血栓（LVT）形成风险的关系。方法：我们对来自单中心的364例前瞻性STEMI患者进行了事后分析。PCI术后中位2天（IQR: 1-3天）进行非对比经胸超声心动图检查。终点是LVT形成，回顾性确定。应用单变量和多变量逻辑回归来评估EPI与LVT形成之间的关系。多变量调整包括LVEF、LAD罪魁祸首、既往心肌梗死、心率和早期心肌松弛速度。采用受试者工作特征曲线下面积（AUC）评价诊断能力。结果与结论364例患者中，31例（8.5%）发生LVT。平均年龄62岁，75%为男性，平均LVEF为46%。发生LVT的患者心率增加，LVEF降低，GLS受损，并且更频繁地发生心肌梗死。与EPI低值相关的变量包括LVEF、左室动脉瘤和GLS。EPI与LVT形成在单变量模型中显著相关（OR = 1.87 (1.53-2.28),p<0.001）， EPI的AUC为0.90。在多变量调整后，EPI和LVT形成仍然显著相关（OR = 1.79 (1.42-2.27),p<0.001）。EPI < 1.0的患者LVT形成的可能性高23倍（OR = 23.41 (10.06-54.49),p<0.001）。EPI和LVT形成在STEMI患者中密切相关，EPI值低表明LVT形成的可能性显著增加。
ObjectiveTo explore the association betweenE-wave propagation index (EPI) as a marker of apical washout and the risk of left ventricular thrombus (LVT) formation in patients with ST-elevation myocardial infarction (STEMI).MethodsWe performed a post-hoc analysis on 364 prospectively enrolled STEMI patients from a single-center. Non-contrast transthoracic echocardiographic examinations were performed a median of 2 days (IQR:1–3 days) after PCI. The endpoint was LVT formation, identified retrospectively. Univariable and multivariable logistic regression was applied to assess the association between EPI and LVT formation. Multivariable adjustments included LVEF, LAD culprit, prior myocardial infarction, heart rate, and early myocardial relaxation velocity. Area under receiver operating characteristic curves (AUC) was used to assess the diagnostic ability.Results and conclusionsAmong 364 patients, 31 (8.5%) developed LVT. The mean age was 62 years, 75% were men, and mean LVEF was 46%. Patients developing LVT had increased heart rate, lower LVEF, impaired GLS, and more frequently had prior myocardial infarction. Variables associated with low values of EPI included, among others, LVEF, LV aneurysm, and GLS. EPI and LVT formation were significantly associated in the univariable model (OR = 1.87 (1.53–2.28),p<0.001), and EPI showed an AUC of 0.90. After multivariable adjustments, EPI and LVT formation remained significantly associated (OR = 1.79 (1.42–2.27),p<0.001). Patients with an EPI < 1.0 had a 23 times higher likelihood of LVT formation (OR = 23.41 (10.06–54.49),p<0.001). EPI and LVT formation are strongly associated in patients with STEMI, with low values of EPI indicating a markedly increased probability of LVT formation.