急性心肌梗死患者经皮冠状动脉介入术后心力衰竭的预测模型及效能评价OACSTPCD

Objective To establish a predictive model and evaluate its diagnostic performance for new onset heart failure after emergent percutaneous coronary intervention(PCI)in patients with acute myocardial infarction(AMI)based on myocardial work ultrasound imaging technology.Methods A total of 193 patients diagnosed with AMI and underwent emergent PCI in Jinhua Municipal Central Hospital were included from January 2021 to March 2023 in this retrospective study.They were followed up for 6 months after discharge,and divided into new onset heart failure group(n=31)and non-heart failure group(n=162)based on left ventricular ejection fraction(LVEF)＜50％.The two groups were compared in general clinical data,conventional ultrasound indicators[left ventricular end diastolic diameter(LVEDd)and left ventricular end diastolic volume(LVEDV),left ventricular end systolic diameter(LVESd)and left ventricular end systolic volume(LVESV)],two-dimensional speckle tracking parameters[global longitudinal strain(GLS)],and myocardial work parameters[global work index(GWI),global constructive work(GCW),global waste work(GWW),and global work efficiency(GWE)].Then least absolute shrinkage and selection operator(LASSO)regression model and multivariate logistic regression were applied to screen risk factors so as to construct the nomogram prediction model.Bootstrap method was used to calculate consistency index,ROC curve was drawn to calculate AUC,and calibration curve and decision curve were used for predictive performance validation.Results The age,peak cardiac troponin I(cTnI),creatine kinase isoenzyme(CK-MB),GLS,and GWW in heart failure group were significantly higher than those of the non-heart failure group(all P＜0.05),while complete revascularization rate,and GWI,GCW,and GWE values were lower(all P＜0.05).LASSO regression and multivariate logistic regression showed that peak cTnI,GLS,and GWW were independent risk factors for new onset heart failure in AMI patients 6 months after emergent PCI,while GWI was a protective factor(all P＜0.05).The consistency index calculated by Bootstrap method was 0.856,and AUC calculated by ROC was 0.893(95％CI:0.842-0.935,P＜0.001),indicating good predic-tive performance of the nomogram.Calibration curve showed the model was in good agreement with the actual occurrence rate;and decision curve showed the model had good clinical net benefit ratio.Conclusion Patients with AMI still have a certain risk of new onset heart failure after emergency PCI,and two-dimensional ultrasound speckle tracking and non-invasive myocardial work imaging technique could effectively evaluate myocardial systolic and diastolic functions;the nomogram model has important practical values in guiding clinical early identification of high-risk populations for new onset heart failure.