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Predictive Significance For Heart Failure And Clinical Effects Of ECW/TBW In Patients With Acute Myocardial Infarction

Posted on:2021-04-01Degree:MasterType:Thesis
Country:ChinaCandidate:R Y ZhangFull Text:PDF
GTID:2404330626959071Subject:Clinical Medicine
Abstract/Summary:PDF Full Text Request
Background:Heart failure after acute myocardial infarction(AMI)is one of clinical common types of heart failure.With the progress of revascularization technology,improvement of diagnosis and treatment methods of myocardial infarction in patients with AMI,the complication rate has gradually decreased.And the incidence of heart failure after myocardial infarction compared with the previous has dcreaesed.But the incidence of heart failure after AMI and the prognosis of patients was tied togather closely.Heart failure after myocardial infarction often leads to poor prognosis.With the rapid development of bioelectrical impedance technology,bioelectrical impedance analysis(BIA)can be used to monitor the fluid status of patients with heart failure.BIA is characterized by non-invasive,convenient implementation,safety,high repeatability,low cost,etc.It can play a role in the diagnosis of patients with acute heart failure(AHF),acute renal failure,chronic renal failure,liver failure,cirrhosis,malnutrition,etcObjectiveThe purpose of this study was to analyze the clinical factors related to ECW/TBW measured by BIA.Explore the clinical effects of ECW/TBW and its function in diagnosis and treatment assistance,disease assessment and prognosis prediction in AMI patients,to provide support for the formulation and adjustment of treatment plans for patients with heart failure after myocardial infarction,and to improve the clinical prognosis of patientsMethods327 AMI patients were admitted to the department of cardiovascular medicine of the first hospital of Jilin university from December 1,2017 to June 1,2018.All of them went through the AMI pathway and received stent implantation.All patients received standardized medical treatment after the surgery.After admission,the general data of the patients and the results of the first laboratory test were recorded.All the patients were carried on BIA to figure out ECW,TBW,and ECW/TBW values.There would be a telephone follow-up lasting from the onset of AMI to the end of the follow-up period Double leg edema,different degrees of dyspnea(exertional dyspnea,orthopnea,nocturnal paroxysmal dyspnea,acute pulmonary edema),or re-admission because of heart failure are considered to be terminal events.After the follow-up,according to whether the terminal event happened or not,the patients are divided into the event group and the non-event group.By analyzing the differences between the event group and the non-event group,the role of ECW/TBW in the diagnosis,treatment,disease assessment and prognosis assessment of heart failure after myocardial infarction is exploredResultsThrough univariate analysis and multivariate analysis,height(β=-0.174,p<0.001),age(β=0.251,p<0.001),hypertension(β=0.060,p=0.030),Killip grading(β=0.539,p<0.001)and BNP(β=0.076,p=0.012)are independent influencing factors of ECW/TBWECW/TBW in the event group was higher than that in the non-event group;The ECW/TBW of patients with Killip grade II was significantly higher than that of Killip gradeI(p<0.001).There was significant linear relationship between ECW/TBW and BNP(B=0.4403,p<0.001),the larger the ECW/TBW,the higher the BNP in patients Among the included patients,there were statistical differences of ECW/TBW in different Killip grades and in the event group and the non-event group,while the difference of BNP in the event group and the non-event group was not statistically significant(p=0.190),indicating that ECW/TBW was more sensitive than BNP in predicting the prognosis of AMI patientsECW/TBW>0.4406 was an independent predictor of heart failure in patients with AMI within 18 months(Adjusted OR=2.959,95%CI=1.399-6.260,p=0.005)Patients were divided into the high-volume load group(ECW/TBW>0.4406,n=161)and the low-volume load group(ECW/TBW≤0.4406,n=166)when put ECW/TBW=0.4406 as the cut-off value.In the high-volume load group,the incidence of terminal events in patients who were treated with diuretics was lower than that in patients without diuretics(p<0.001)Conclusions1.Height,age,hypertension,Killip grading,and BNP are all independent influencing factors of ECW/TBW of AMI acute stage in AMI patients2.BNP has a significant linear relationship with ECW/TBW(B=0.4403,p<0.001)and ECW/TBW is more sensitive to predict the incidence of heart failure in AMI patients.The ECW/TBW has some potential as a supplementary detection method for BNP,and can also independently play a role in fluid load assessment and act as a prognostic predictive factor for patients with AMI3.ECW/TBW>0.4406 was an independent predictor of the incidence of heart failure within 18 months in AMI patients4.ECW/TBW>0.4406 has implications for the timing of diuretic use in AMI patients.
Keywords/Search Tags:acute myocardial infarction, heart failure, bioelectrical impedence analysis, fluid management, fluid status
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