Value Of Echocardiography For Prediction Of Cardiac Rupture In Patients With Acute Myocardial Infarction

ObjectiveThis study was to observe the clinical relevance of echocardiography in the prediction of cardiac rupture(CR)in patients with acute myocardial infarction(AMI).MethodsForty-nine patients with CR from 1246 patients with AMI were retrospectively identified between Jan,2012 and Sep,2016 in Fujian Union Hospital,who was matched to Non-CR patients with propensity score matching(PSM)according to age,gender,hematocrit,hypertension,systolic blood pressure,diastolic blood pressure,diabetes mellitus,fasting blood-glucose,the peak troponin I,ST segment elevation,reperfusion therapy(percutaneous coronary intervention or thrombolysis),and reperfusion therapy results.After 1:3 matching,47 CR and 130 non-CR patients were matched.After PSM,we compared clinical characteristics and echocardiography data between the two groups with logistic regression model to explore the risk factors associated with CR.ResultsBefore PSM matching,the baseline characteristics in non-CR group and CR group were no significant difference in the gender,hematocrit,hypertension,diastolic blood pressure,diabetes mellitus(P > 0.05),and significant difference in the age(63.9±12.1years vs 68.8±11.0years,P=0.005),the peak troponin I(14.0±18.1ug/l vs19.2±18.8ug/l,P=0.049),ST segment elevation(48.6% vs 81.6%,P=0.000).Systolic blood pressure(126.6±21.9mmHg vs 115.6±20.7mmHg,P=0.001),reperfusion therapy(81.4% vs 30.6%,P=0.000),successful reperfusion therapy(80.9% vs 28.6%,P=0.000.After 1:3 matching,the two groups had similar baseline characteristics.After PSM,univariate logistic regression revealed that there was no significant difference in left ventricular end diastolic diameter(LVED),left ventricular ejection fraction(LVEF),infarcted myocardial motion hypokinesis and adjacent segmentshyperkinesis of non-infarcted area,left ventricular aneurysm(LVA),but significant difference in myocardial thinning,regional wall motion abnormality segments(RWMAS)between the two groups.Multivariate logistic regression analysis showed that RWMAS [odds ratio(OR): 1.205(95% CI: 1.088-1.335;P < 0.001)] and moderate-severe myocardial thinning [OR: 1.698(95%CI: 1.110-2.597;P < 0.05)]were the risk factors in the presence of CR.Multivariate logistic regression revealed that the moderate-severe myocardial thinning(OR: 1.755,95%CI: 1.072-2.874;P<0.05),extensive RWMA(OR: 1.257,95%CI: 1.117-1.414;P < 0.001),the small-moderate pericardial effusion(OR: 1.452,95%CI: 1.077-1.959;P<0.05),the early pericardial effusion(OR: 1.415,95%CI: 1.042-1.922;P<0.05)were the risk factors in the presence of free wall rupture(FWR).ConclusionsEchocardiography has the predictive value for CR in patients with AMI.The moderate-severe myocardial thinning,extensive wall motion abnormalities are associated with CR;and the moderate-severe myocardial thinning,extensive RWMA,small-moderate pericardial effusion and early pericardial effusion are the echocardiographic predictors for FWR.