Meimoun Patrick, Malaquin Dorothée, Benali Tahar, Boulanger Jacques, Zemir Hamdane, Sayah Smain, Luycx-Bore Anne, Doutrelan Luc, Tribouilloy Christophe
Department of Cardiology and Intensive Care Unit, Compiègne Hospital, Compiègne, France.
J Am Soc Echocardiogr. 2009 Sep;22(9):1071-9. doi: 10.1016/j.echo.2009.05.017. Epub 2009 Jul 31.
The prediction of left ventricular (LV) recovery and adverse cardiac events after reperfused acute myocardial infarction (AMI) is challenging. The aim of this study was to assess the usefulness of noninvasive coronary flow reserve (CFR) to predict LV recovery and in-hospital adverse cardiac events after AMI by comparison with other available tools.
Fifty-five consecutive patients (mean age, 59 +/- 13 years; 33% women) with first reperfused ST-elevation anterior AMIs and sustained Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow underwent prospectively, < 24 hours after successful primary coronary angioplasty, standard echocardiography and noninvasive CFR assessment in the distal part of the left anterior descending coronary artery, using intravenous adenosine infusion, while in a stable hemodynamic situation. CFR was defined as peak hyperemic left anterior descending coronary artery flow velocity divided by baseline flow velocity. LV ejection fraction (LVEF) was measured using the biplane Simpson's rule. A no-reflow pattern was defined as diastolic deceleration time of basal diastolic coronary flow velocity < 600 ms and/or systolic flow reversal and recovery of LV function as an absolute increase of LVEF >or= 10% at 3-month follow-up. Adverse events were defined as the composite of death, recurrent AMI, and acute heart failure.
In the whole population, the mean LVEF was 46 +/- 5% at baseline and 55 +/- 9% at follow-up. Patients without LV recovery had more severely impaired CFR compared with those with LV recovery (2.1 +/- 0.55 vs 1.46 +/- 0.2, P < .001), as did patients with adverse events compared with those without events (P = .01). Furthermore, CFR was significantly correlated with 3-month LVEF and regional wall motion score (both P values < .01). On multivariate analysis, CFR was an independent predictor of global and regional LV function at follow-up (both P values <or= .01) and of in-hospital cardiac events (P = .02). Receiver-operating characteristic curve analysis demonstrated that a cutoff value of 1.7 for CFR yielded sensitivity of 76% and specificity of 96% to predict LV recovery at follow-up (P < .01).
Noninvasive CFR determined < 24 hours after AMI was an independent predictor of LV recovery at 3-month follow-up and of in-hospital adverse cardiac events.
预测再灌注急性心肌梗死（AMI）后左心室（LV）恢复情况及不良心脏事件具有挑战性。本研究旨在通过与其他现有工具比较，评估无创冠状动脉血流储备（CFR）对预测AMI后LV恢复情况及院内不良心脏事件的有效性。
连续入选55例首次再灌注的ST段抬高型前壁AMI患者（平均年龄59±13岁；33%为女性），成功进行直接冠状动脉血管成形术后<24小时，在血流动力学稳定状态下，采用静脉注射腺苷，对左前降支冠状动脉远端进行标准超声心动图检查及无创CFR评估。CFR定义为充血期左前降支冠状动脉峰值血流速度除以基础血流速度。采用双平面Simpson法则测量LV射血分数（LVEF）。无复流模式定义为基础舒张期冠状动脉血流速度的舒张期减速时间<600毫秒和/或收缩期血流逆转，LV功能恢复定义为3个月随访时LVEF绝对增加≥10%。不良事件定义为死亡、再发AMI和急性心力衰竭的复合事件。
在整个研究人群中，基线时平均LVEF为46±5%，随访时为55±9%。与LV恢复的患者相比，未恢复LV的患者CFR受损更严重（2.1±0.55对1.46±0.2，P<.001），不良事件患者与无事件患者相比也是如此（P=.01）。此外，CFR与3个月时的LVEF及节段性室壁运动评分显著相关（P值均<.01）。多因素分析显示，CFR是随访时整体和局部LV功能（P值均≤.01）及院内心脏事件（P=.02）的独立预测因素。受试者工作特征曲线分析表明，CFR的截断值为1.7时，预测随访时LV恢复的敏感性为76%，特异性为96%（P<.01）。
AMI后<24小时测定的无创CFR是3个月随访时LV恢复及院内不良心脏事件的独立预测因素。
