Abstract:Aim To compare tissue motion mitral annular displacement (TMAD) and volumetric indices in patients with acute myocardial infarction (AMI) under different volume load conditions, and to analyze their correlation and predictive value for patient prognosis. Methods The clinical data of 164 patients with AMI were collected, and they were divided into volume overload group (n＝98) and non-volume overload group (n＝66) according to the relative volume balance level of patients. All patients were followed up for 30 days, and further classified into poor prognosis group (n＝70) and good prognosis group (n＝94) based on the occurrence of death or rehospitalization. The general data, TMAD parameters and volumetric indexes were compared between groups. The Pearson correlation analysis was used to assess the correlation between TMAD parameters and volumetric indexes. Multivariate Logistic regression analysis was performed to analyze the influencing factors of poor prognosis of AMI patients. A generalized linear model was employed to evaluate the effect of volume load on the regression relationship between TMAD parameters and prognosis. ROC curves were used to assess the efficacy of TMAD parameters and volumetric indexes in predicting poor prognosis in patients with AMI. Results Compared with the non-volume overload group, patients in the volume overload group had lower systolic blood pressure (SBP), diastolic blood pressure (DBP), TMAD parameters, albumin (ALB), hemoglobin (Hb), and hematocrit (HCT) levels, while their sequential organ failure assessment (SOFA) scores, simplified acute physiology score Ⅱ (SAPS Ⅱ) scores, creatinine, blood urea nitrogen (BUN), pulmonary capillary wedge pressure (PCWP), and central venous pressure (CVP) were higher (P＜0.05). Correlation analysis showed that the maximal displacement of the annulus at the interventricular septum (TMAD1), the maximal displacement of the annulus at the left ventricular lateral wall (TMAD2), and the maximal displacement at the midpoint of the mitral annulus between the interventricular septum and lateral wall (TMADMidpt) and its percentage of left ventricular long axis (TMADMidpt%) were all significantly positively correlated with ALB, Hb and HCT, and significantly negatively correlated with PCWP and CVP (all P＜0.001). Compared with the good prognosis group, the poor prognosis group had a higher proportion of volume overload, lower TMAD1, TMAD2, TMADMidpt and HCT levels, and higher PCWP and CVP levels (all P＜0.05). Increases in TMAD1, TMAD2, TMADMidpt and HCT were independent protective factors affecting patient prognosis, whereas increased volume load, PCWP and CVP were independent risk factors affecting patient prognosis (all P＜0.05). Results from the generalized linear model showed that as TMAD parameters increased, the negative correlation between volume load and poor prognosis gradually strengthened. ROC curve analysis showed that the combined detection of TMAD parameters (including TMAD1, TMAD2, TMADMidpt) and volume-related indicators (including HCT, PCWP, CVP) had an AUC of 0.971 (95%CI:0.952～0.986, P＜0.001), which was higher than for any individual indicator (TMAD1, TMAD2, TMADMidpt, HCT, PCWP, CVP), for the combined TMAD parameters (TMAD1, TMAD2, TMADMidpt), and for the combined volume-related indicators (HCT, PCWP, CVP). Conclusion TMAD can be used as an effective indicator to evaluate the volume load and prognosis of patients with AMI, combination detection with volumetric indexes can further improve the accuracy of prognosis prediction.
