急性心肌梗死后左心室不同步是左心室重构的有力指标。
Left Ventricular Dyssynchrony After Acute Myocardial Infarction is a Powerful Indicator of Left Ventricular Remodeling.
机构信息
The Heart Center of Chonnam National University Hospital, Cardiovascular Research Institute of Chonnam National University, Gwangju, Korea.
出版信息
Korean Circ J. 2009 Jun;39(6):236-42. doi: 10.4070/kcj.2009.39.6.236. Epub 2009 Jun 30.
BACKGROUND AND OBJECTIVES
Left ventricular (LV) remodeling (LVR) after an acute myocardial infarction (AMI) has important clinical implications. We have investigated the prognostic relevance of ventricular systolic dyssnchrony as an indicator of LVR after an AMI.
SUBJECTS AND METHODS
We enrolled 92 patients (males, 72.8%; mean age, 61.0+/-13.0 years) with an AMI who underwent successful percutaneous coronary intervention. We analyzed the baseline characteristics, the laboratory and echocardiographic findings, and we performed follow-up echocardiography 6 months after the AMI. The patients were divided into two groups: 1) the presence of LVR, which was defined as an increment of LV end systolic volume (LVESV) >20% compared with the baseline examination; and 2) the absence of LVR.
RESULTS
Twenty-seven patients (29.3%) developed LVR after a 6 month follow-up. There was no statistically significant difference in the clinical and angiographic findings between the two groups. With respect to the laboratory findings, the LVR group had a higher peak creatine kinase MB (CK-MB) (149.9+/-155.0 vs. 74.6+/-69.7 U/L, p=0.001) and troponin-I (70.2+/-73.3 vs. 43.2+/-39.5 ng/mL, p=0.024) level than the group without LVR. With respect to echocardiographic findings, the baseline LV ejection fraction (EF) and LVESV were not significantly different (LVESV, 73.0+/-37.3 vs. 91.3+/-52.0 mL, p=0.013; and EF, 58.3+/-13.3 vs. 55.6+/-11.8%, p=0.329) between the groups with and without LVR, respectively. The degree of LV dyssynchrony, which was assessed by tissue Doppler imaging, was significantly higher in the LVR group than the group without LVR (75.2+/-43.4 vs. 38.3+/-32.5 ms), and the degree of LV dyssynchrony was an independent predictor for LVR based on multivariate analysis {hazard ratio (HR)=0.097, p<0.001}. In receiver operating characteristics (ROC) curve analysis, the area under the curve (AUC) was 0.754 and a cutoff value of 45.9 predicted the development of LVR with 74.1% sensitivity and 72.3% specificity.
CONCLUSION
The presence of LV dyssynchroncy immediately after a myocardial infarction is an important predictive factor for development LVR.
背景与目的
急性心肌梗死（AMI）后左心室（LV）重构（LVR）具有重要的临床意义。我们研究了心室收缩不同步作为 AMI 后 LVR 的指标的预后相关性。
对象与方法
我们纳入了 92 例成功接受经皮冠状动脉介入治疗的 AMI 男性患者（72.8%），平均年龄 61.0±13.0 岁。分析基线特征、实验室和超声心动图结果，并在 AMI 后 6 个月进行随访超声心动图检查。患者分为两组：1）LVR 组，定义为 LV 收缩末期容积（LVESV）较基线检查增加>20%；2）无 LVR 组。
结果
27 例（29.3%）患者在 6 个月随访时发生 LVR。两组的临床和血管造影特征无统计学差异。在实验室检查方面，LVR 组肌酸激酶同工酶 MB（CK-MB）（149.9±155.0 比 74.6±69.7 U/L，p=0.001）和肌钙蛋白 I（70.2±73.3 比 43.2±39.5 ng/mL，p=0.024）峰值更高。在超声心动图检查方面，LV 射血分数（EF）和 LVESV 的基线值在 LVR 组和无 LVR 组之间无显著差异（LVESV，73.0±37.3 比 91.3±52.0 mL，p=0.013；EF，58.3±13.3 比 55.6±11.8%，p=0.329）。组织多普勒成像评估的 LV 不同步程度在 LVR 组明显高于无 LVR 组（75.2±43.4 比 38.3±32.5 ms），多变量分析显示 LV 不同步程度是 LVR 的独立预测因素（风险比[HR]=0.097，p<0.001）。在受试者工作特征（ROC）曲线分析中，曲线下面积（AUC）为 0.754，截断值为 45.9 预测 LVR 发展的灵敏度为 74.1%，特异性为 72.3%。
结论
心肌梗死后即刻出现的 LV 不同步是 LVR 发展的重要预测因素。
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