PDF(Pubmed)
Abstract：
OBJECTIVE: In this study, we explored the determinants of ventricular aneurysm development following acute myocardial infarction (AMI), thereby prompting timely interventions to enhance patient prognosis.
METHODS: In this retrospective cohort analysis, we evaluated 297 AMI patients admitted to the First People\'s Hospital of Changzhou. The study was structured as follows. Comprehensive baseline data collection included hematological evaluations, ECG, echocardiography, and coronary angiography upon admission. Within 3 months post-AMI, cardiac ultrasounds were administered to detect ventricular aneurysm development. Univariate and multivariate logistic regression analysis were employed to pinpoint the determinants of ventricular aneurysm formation. Subsequently, a predictive model was formulated for ventricular aneurysm post-AMI. Moreover, the diagnostic efficacy of this model was appraised using the ROC curves.
RESULTS: In our analysis of 291 AMI patients, spanning an age range of 32-91 years, 247 were male (84.9%). At the conclusion of a 3-month observational period, the cohort bifurcated into two subsets: 278 patients without ventricular aneurysm and 13 with evident ventricular aneurysm. Distinguishing features of the ventricular aneurysm subgroup were markedly higher values for age, B-type natriuretic peptide(BNP), Left atrium(LA), Left ventricular end-diastolic dimension (LEVDD), left ventricular end systolic diameter (LVEWD), E-wave velocity (E), Left atrial volume (LAV), E/A ratio (E/A), E/e ratio (E/e), ECG with elevated adjacent four leads(4 ST-Elevation), and anterior wall myocardial infarction(AWMI) compared to their counterparts (p < 0.05). Among the singular predictive factors, total cholesterol (TC) emerged as the most significant predictor for ventricular aneurysm development, exhibiting an AUC of 0.704. However, upon crafting a multifactorial model that incorporated gender, TC, an elevated ST-segment in adjacent four leads, and anterior wall infarction, its diagnostic capability: notably surpassed that of the standalone TC, yielding an AUC of 0.883 (z = -9.405, p = 0.000) as opposed to 0.704. Multivariate predictive model included gender, total cholesterol, ST elevation in 4 adjacent leads, anterior myocardial infarction, the multivariate predictive model showed better diagnostic efficacy than single factor index TC (AUC: 0. 883 vs. 0.704,z =-9.405, p = 0.000), it also improved predictive power for correctly reclassifying ventricular aneurysm occurrence in patients with AMI, NRI = 28.42% (95% CI: 6.29-50.55%; p = 0.012). Decision curve analysis showed that the use of combination model had a positive net benefit.
CONCLUSIONS: Lipid combined with ECG model after myocardial infarction could be used to predict the formation of ventricular aneurysm and aimed to optimize and adjust treatment strategies.
METHODS: In this retrospective cohort analysis, we evaluated 297 AMI patients admitted to the First People\'s Hospital of Changzhou. The study was structured as follows. Comprehensive baseline data collection included hematological evaluations, ECG, echocardiography, and coronary angiography upon admission. Within 3 months post-AMI, cardiac ultrasounds were administered to detect ventricular aneurysm development. Univariate and multivariate logistic regression analysis were employed to pinpoint the determinants of ventricular aneurysm formation. Subsequently, a predictive model was formulated for ventricular aneurysm post-AMI. Moreover, the diagnostic efficacy of this model was appraised using the ROC curves.
RESULTS: In our analysis of 291 AMI patients, spanning an age range of 32-91 years, 247 were male (84.9%). At the conclusion of a 3-month observational period, the cohort bifurcated into two subsets: 278 patients without ventricular aneurysm and 13 with evident ventricular aneurysm. Distinguishing features of the ventricular aneurysm subgroup were markedly higher values for age, B-type natriuretic peptide(BNP), Left atrium(LA), Left ventricular end-diastolic dimension (LEVDD), left ventricular end systolic diameter (LVEWD), E-wave velocity (E), Left atrial volume (LAV), E/A ratio (E/A), E/e ratio (E/e), ECG with elevated adjacent four leads(4 ST-Elevation), and anterior wall myocardial infarction(AWMI) compared to their counterparts (p < 0.05). Among the singular predictive factors, total cholesterol (TC) emerged as the most significant predictor for ventricular aneurysm development, exhibiting an AUC of 0.704. However, upon crafting a multifactorial model that incorporated gender, TC, an elevated ST-segment in adjacent four leads, and anterior wall infarction, its diagnostic capability: notably surpassed that of the standalone TC, yielding an AUC of 0.883 (z = -9.405, p = 0.000) as opposed to 0.704. Multivariate predictive model included gender, total cholesterol, ST elevation in 4 adjacent leads, anterior myocardial infarction, the multivariate predictive model showed better diagnostic efficacy than single factor index TC (AUC: 0. 883 vs. 0.704,z =-9.405, p = 0.000), it also improved predictive power for correctly reclassifying ventricular aneurysm occurrence in patients with AMI, NRI = 28.42% (95% CI: 6.29-50.55%; p = 0.012). Decision curve analysis showed that the use of combination model had a positive net benefit.
CONCLUSIONS: Lipid combined with ECG model after myocardial infarction could be used to predict the formation of ventricular aneurysm and aimed to optimize and adjust treatment strategies.
摘要：
目的：在本研究中，我们探讨了急性心肌梗死（AMI）后室壁瘤发展的决定因素，从而促使及时干预,提高患者预后。
方法：在本回顾性队列分析中，我们评估了常州市第一人民医院收治的297例AMI患者。本研究的结构如下。全面的基线数据收集包括血液学评估，心电图,超声心动图,入院时冠状动脉造影。AMI后3个月内，心脏超声检查用于检测室壁瘤的发展.采用单变量和多变量逻辑回归分析来确定室壁瘤形成的决定因素。随后，建立了AMI后室壁瘤的预测模型.此外，使用ROC曲线评价该模型的诊断效能.
结果：在我们对291例AMI患者的分析中，年龄范围为32-91岁，247人为男性（84.9%）。在为期3个月的观察期结束时，该队列分为两个子集：278例无室壁瘤患者和13例有明显室壁瘤患者。室壁瘤亚组的区别特征是年龄明显较高的值，B型利钠肽（BNP），左心房(LA),左心室舒张末期内径(LEVDD),左心室收缩末期直径（LVEWD），E波速度（E），左心房容积(LAV),E/A比（E/A），E/E比（E/E），相邻四根导线升高的心电图(4个ST段抬高),和前壁心肌梗死（AWMI）相比，它们的对应物（p<0.05）。在奇异的预测因素中，总胆固醇（TC）成为心室动脉瘤发展的最重要预测因子，表现出0.704的AUC。然而,在构建一个融合性别的多因素模型时，TC,相邻四导联的ST段抬高,和前壁梗塞，它的诊断能力：明显超过了独立TC，产生的AUC为0.883(z=-9.405，p=0.000)，而不是0.704。多变量预测模型包括性别，总胆固醇,4个相邻导线的ST抬高,前壁心肌梗死,多因素预测模型显示出比单因素指标TC更好的诊断效能(AUC:0.883vs.0.704，z=-9.405，p=0.000），它还提高了正确重新分类AMI患者室壁瘤发生的预测能力，NRI=28.42%（95%CI：6.29-50.55%；p=0.012）。决策曲线分析表明，使用组合模型具有正的净收益。
结论：血脂联合心电图模型可用于预测心肌梗死后室壁瘤的形成，旨在优化和调整治疗策略。
方法：在本回顾性队列分析中，我们评估了常州市第一人民医院收治的297例AMI患者。本研究的结构如下。全面的基线数据收集包括血液学评估，心电图,超声心动图,入院时冠状动脉造影。AMI后3个月内，心脏超声检查用于检测室壁瘤的发展.采用单变量和多变量逻辑回归分析来确定室壁瘤形成的决定因素。随后，建立了AMI后室壁瘤的预测模型.此外，使用ROC曲线评价该模型的诊断效能.
结果：在我们对291例AMI患者的分析中，年龄范围为32-91岁，247人为男性（84.9%）。在为期3个月的观察期结束时，该队列分为两个子集：278例无室壁瘤患者和13例有明显室壁瘤患者。室壁瘤亚组的区别特征是年龄明显较高的值，B型利钠肽（BNP），左心房(LA),左心室舒张末期内径(LEVDD),左心室收缩末期直径（LVEWD），E波速度（E），左心房容积(LAV),E/A比（E/A），E/E比（E/E），相邻四根导线升高的心电图(4个ST段抬高),和前壁心肌梗死（AWMI）相比，它们的对应物（p<0.05）。在奇异的预测因素中，总胆固醇（TC）成为心室动脉瘤发展的最重要预测因子，表现出0.704的AUC。然而,在构建一个融合性别的多因素模型时，TC,相邻四导联的ST段抬高,和前壁梗塞，它的诊断能力：明显超过了独立TC，产生的AUC为0.883(z=-9.405，p=0.000)，而不是0.704。多变量预测模型包括性别，总胆固醇,4个相邻导线的ST抬高,前壁心肌梗死,多因素预测模型显示出比单因素指标TC更好的诊断效能(AUC:0.883vs.0.704，z=-9.405，p=0.000），它还提高了正确重新分类AMI患者室壁瘤发生的预测能力，NRI=28.42%（95%CI：6.29-50.55%；p=0.012）。决策曲线分析表明，使用组合模型具有正的净收益。
结论：血脂联合心电图模型可用于预测心肌梗死后室壁瘤的形成，旨在优化和调整治疗策略。
