超声心动图参数构建列线图评估ST段抬高型心肌梗死患者PCI术后心力衰竭风险OA

Objective To develop a nomogram based on echocardiographic parameters for predicting the risk of heart failure(HF)after percutaneous coronary intervention(PCI)in patients with ST-segment elevation myocardial infarction(STEMI).Methods A total of 145 STEMI patients who underwent PCI at Nanjing Gaochun People's Hospital from October 2021 to May 2023 were enrolled.All patients were followed up for 1 year,9 patients were lost to follow-up,and the remaining patients were divided into an HF group(65 cases)and a non-HF group(71 cases)according to the occurrence of HF during follow-up.Clinical data and laboratory indicators were collected.Echocardiographic parameters were obtained by Doppler ultrasound examination.Univariate and multivariate analyses were used to identify risk factors for HF in STEMI patients after PCI.The identified risk factors were incorporated into R software to construct a nomogram prediction model.The performance of the constructed prediction model was subsequently validated.Results The proportion of hyperlipidemia and multiple vessel lesions,and the levels of N-terminal pro-B-type natriuretic peptide(NT-proBNP),neutrophil-to-lymphocyte ratio(NLR),end-diastolic interventricular septal thickness(IVST),and left ventricular end-diastolic dimension(LVEDD)in the HF group were all higher than those in the non-HF group(χ2/t=10.699,7.191,17.207,10.781,5.341,4.340,respectively;all P<0.05).Conversely,left ventricular ejection fraction(LVEF)and left ventricular fractional shortening(LVFS)levels were significantly lower in the HF group(t=2.255,6.888,respectively;P<0.05).Logistic regression analysis showed that hyperlipidemia,multi-vessel lesions,NT-proBNP,NLR,IVST,LVFS,and LVEDD were risk factors for HF in STEMI patients after PCI(OR=3.367,3.013,5.801,4.129,2.385,2.776,2.186,respectively;all P<0.05).The nomogram model demonstrated an area under the ROC curve(AUC)of 0.892(95ﾣCI=0.679ﾡ0.998),and the sensitivity and specificity were 96.80ﾣ and 79.40ﾣ,respectively(both P<0.01),indicating a strong predictive performance for HF risk after PCI in STEMI patients.Both the predicted and the actual values aligned closely with the ideal curve,and the Hosmer-Lemeshow goodness-of-fit test yielded a non-significant result(χ2=2.325,P>0.05),suggesting good calibration and model fit.Conclusion The nomogram model based on echocardiographic parameters demonstrates high predictive value for HF after PCI in STEMI patients,and can assist clinicians in formulating individualized medical plans.