【摘要】 目的:应用心肌自动功能成像(AFI)评估心肌切除术前肥厚型心肌病(HCM)患者右心室功能，探讨其与心肌切除术后围术期不良事件发生风险的相关性及其预测价值。方法:连续性选取2025年1月—2025年7月在华中科技大学同济医学院附属同济医院接受心肌切除术后的HCM患者118例。根据患者心肌切除术后围术期内是否发生不良事件将其分为不良事件组20例和未发生不良事件组98例。应用常规超声心动图和AFI分别测量左、右心室功能参数。比较两组间一般资料、常规超声心动图参数和AFI参数，采用ROC曲线分析超声参数对不良事件发生的预测效能，并应用Firth惩罚最大似然法进行logistic回归分析影响HCM心肌切除术患者预后的独立危险因素。结果:不良事件组左心室整体纵向心肌应变(LVGLS)、右心室四腔心纵向应变(RV4CLS)、右心室游离壁纵向应变(RVFWLS)低于未发生不良事件组(均P<0.05)。Logistic回归分析结果显示，RV4CLS、RVFWSL是患者围术期发生不良事件的独立风险因素(OR:1.19,95%CI 1.03～1.40,P=0.015;OR:1.09,95%CI 1.01～1.20,P=0.036)。RV4CLS预测围术期发生不良事件的ROC曲线下面积(AUC)为0.73(0.62～0.84),截断值为-20.4%,灵敏度和特异度分别为69%和74%;RVFWLS预测围术期发生不良事件的AUC为0.70(0.60～0.83),截断值为-24.2%,灵敏度和特异度分别为65%和70%。结论:RVFWLS和RV4CLS在预测心肌切除术患者围术期不良事件中具有一定的预测价值，右心室AFI能够提供快速、客观、量化的参数信息，有望作为围术期风险评估的辅助工具。更多还原

【Abstract】 Objective: To evaluate preoperative right ventricular(RV) function in patients with hypertrophic cardiomyopathy(HCM) undergoing septal myectomy using automated functional imaging(AFI), and to investigate its association with the risk of perioperative adverse events. Methods: A total of 118 patients with HCM who underwent septal myectomy at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, between January 2025 and July 2025 were enrolled. Patients were divided into an adverse event group(n=20) and a non-adverse event group(n=98) according to whether perioperative adverse events occurred. Conventional echocardiography and AFI were used to measure left and right ventricular functional parameters. Baseline characteristics, conventional echocardiographic parameters, and AFI parameters were compared between the two groups. Receiver operating characteristic(ROC) curve analysis was performed to evaluate the predictive value of echocardiographic parameters for perioperative adverse events. Firth’s penalized logistic regression analysis was used to identify independent risk factors affecting postoperative outcomes. Results: Compared with the non-adverse event group, patients in the adverse event group had significantly lower left ventricular global longitudinal strain(LVGLS), right ventricular four-chamber longitudinal strain(RV4CLS), and right ventricular free wall longitudinal strain(RVFWLS)(all P<0.05). Logistic regression analysis showed that RV4CLS and RVFWLS were independent risk factors for perioperative adverse events(OR=1.19, 95%CI: 1.03～1.40, P=0.015; OR=1.09, 95%CI: 1.01～1.20, P=0.036). The area under the ROC curve(AUC) for RV4CLS in predicting perioperative adverse events was 0.73(95%CI: 0.62-0.84), with a cutoff value of-20.4%, sensitivity of 69%, and specificity of 74%. The AUC for RVFWLS was 0.70(95%CI: 0.60-0.83), with a cutoff value of-24.2%, sensitivity of 65%, and specificity of 70%. Conclusion: RVFWLS and RV4CLS are valuable predictors of perioperative adverse events in patients undergoing septal myectomy. AFI provides rapid, objective quantitative parameters, serving as a supplementary tool for perioperative risk assessment.更多还原