Predictive value of intravascular ultrasound and two-dimensional speckle tracking parameters for myocardial injury and major adverse cardiovascular events in patients with acute ST segment elevation myocardial infarction

BAI Jing-miao; SHI Su-na; JIA Xiang-ke

doi:10.3969/j.issn.1672-5301.2024.11.014

Abstract：Objective To explore the predictive value of intravascular ultrasound(IVUS)combined with two-dimensional speckle tracking(2D-STI)parameters for myocardial injury and major adverse cardiovascular events(MACE)after percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 225 patients with acute STEMI admitted to Xingtai Central Hospital from January 2017 to December 2020 were included in the study and all underwent PCI.After the surgery,imaging examinations such as IVUS and 2D-STI were performed,and indicators of myocardial injury were measured.The correlation between the measurements of IVUS and 2D-STI and myocardial injury indicators was analyzed by the Pearson method.During the 12-month follow-up period,3 patients were lost to follow-up.According to whether MACE occurred,the patients were divided into the MACE group(n=43)and non-MACE group(n=1 79).The basic situation of STEMI patients was analyzed by univariate analysis;and logistic regression analysis was used to identify the influencing factors of MACE.The ROC curve was used to evaluate the diagnostic ability of IVUS and 2D-STI parameters in predicting MACE.Results The concentration of creatine kinase CK-MB in 225 patients with acute STEMI was(16.23±3.09)U/L,and the level of cardiac troponin cTnI was(0.36±0.05)ng/L.The parameters of 2D-STI and the minimum lumen diameter(MLD)and minimum lumen area(MLA)had a significant negative correlation with the concentrations of CK-MB and cTnI(P＜0.05),while the measurement of area stenosis rate(AS)was positively correlated with the concentrations of these two biochemical indicators(P＜0.05).Further analysis found that the AS value of the MACE group was significantly higher than that of the non-MACE group,with a statistically significant difference(P＜0.05).The MLD,MLA,global circumferential strain(CS),global radial strain(RS),and longitudinal strain(LS)values of patients in the MACE group were significantly lower than those of patients in the non-MACE group.Logistic regression analysis found that MLA,AS,RS and LS were the main factors affecting the occurrence of MACE.The ROC curve further verifies the predictive value of these parameters.Among them,the critical value of MLA was 3.56 mm2,that of AS was 69.87％,that of RS was 29.87％,and that of LS was 23.05％.The sensitivities and specificities were 69.77％and 70.95％,81.40％and 71.51％,60.47％and 61.45％,86.05％and 79.33％respectively.The AUC value showed that the above parameters had good discriminating ability,especially the AUC value of LS was as high as 0.899(95％CI 0.799-0.999),while the sensitivity and specificity of the overall regression analysis reached 95.35％and 94.41％,and the AUC value was 0.993(95％CI 0.979-1.000).Conclusion Intravascular ultrasound and two-dimensional strain imaging technology provide accurate imaging support for the assessment of myocardial damage in patients with acute STEMI.Their related quantitative indicators show significant abnormal expression when MACE occurs in patients with acute STEMI.They would become the important factors in predicting MACE risk.