Cerisano Giampaolo, Pucci Paolo Domenico, Valenti Renato, Boddi Vieri, Migliorini Angela, Tommasi Maria Silvia, Raspanti Silvia, Parodi Guido, Antoniucci David
Division of Cardiology, Department of Clinical Physiopathology, Careggi Hospital, Florence, Italy.
Am J Cardiol. 2005 Apr 15;95(8):930-4. doi: 10.1016/j.amjcard.2004.12.029.
The correlation between Doppler deceleration time (DT) and brain natriuretic peptide (BNP) and their predictive value for detecting left ventricular (LV) remodeling in patients who are treated with primary percutaneous intervention for infarction and LV dysfunction are unknown. Fifty-six patients (64 +/- 12 years of age; 11 women) who had a first ST-segment elevation myocardial infarction and systolic dysfunction that was successfully treated with direct primary coronary intervention underwent 2-dimensional Doppler echocardiographic and plasma BNP evaluation at days 1 and 3 and 1 and 6 months after the index infarction. Repeat coronary angiograms were obtained at 1 and 6 months. Because of previous consistent evidence, 3 days after the index infarction was the time point of comparison between BNP and DT values. Echocardiographic LV remodeling was defined as an increase in end-diastolic volume index above baseline values of 2 x SD. Ventricular remodeling occurred in 20 patients (36%). Multivariate analyses that included BNP level, Doppler DT, echocardiographic measurements of systolic function, peak creatine kinase, and anterior infarct location showed Doppler DT to be the only predictor of LV remodeling (odds ratio 0.963, 95% confidence interval 0.936 to 0.990, p = 0.008). The optimal cutoff for DT in the prediction of 6-month LV remodeling was <136 ms (sensitivity 75%, specificity 97%, accuracy 81%, area under receiver-operating characteristic curve 0.90). Thus, in patients who have a first ST-segment elevation myocardial infarction and LV systolic dysfunction that is successfully treated with primary percutaneous coronary intervention, Doppler-derived DT 3 days after index infarction is more effective than BNP level in detecting patients who are at higher risk for 6-month LV remodeling.
对于接受心肌梗死和左心室功能障碍的直接经皮介入治疗的患者，多普勒减速时间（DT）与脑钠肽（BNP）之间的相关性及其对检测左心室（LV）重构的预测价值尚不清楚。56例患者（年龄64±12岁；11例女性）首次发生ST段抬高型心肌梗死且伴有收缩功能障碍，经直接冠状动脉介入治疗成功后，在梗死指数后的第1天、第3天以及1个月和6个月时接受二维多普勒超声心动图和血浆BNP评估。在1个月和6个月时进行重复冠状动脉造影。由于先前有一致的证据，梗死指数后3天是比较BNP和DT值的时间点。超声心动图左心室重构定义为舒张末期容积指数高于基线值2倍标准差。20例患者（36%）发生心室重构。多因素分析包括BNP水平、多普勒DT、收缩功能的超声心动图测量、肌酸激酶峰值和前壁梗死部位，结果显示多普勒DT是左心室重构的唯一预测因子（优势比0.963，95%置信区间0.936至0.990，p = 0.008）。预测6个月左心室重构时DT的最佳截断值<136 ms（敏感性75%，特异性97%，准确性81%，受试者操作特征曲线下面积0.90）。因此，对于首次发生ST段抬高型心肌梗死且左心室收缩功能障碍并经直接经皮冠状动脉介入治疗成功的患者，梗死指数后3天的多普勒衍生DT在检测6个月左心室重构高风险患者方面比BNP水平更有效。
