微血管阻塞仍然是急性心肌梗死后左心室收缩功能障碍的最佳治疗患者不良重构的先兆。

Microvascular obstruction remains a portent of adverse remodeling in optimally treated patients with left ventricular systolic dysfunction after acute myocardial infarction.

机构信息

Cardiology Department, Western Infirmary, Glasgow, Scotland, United Kingdom.

出版信息

Circ Cardiovasc Imaging. 2010 Jul;3(4):360-7. doi: 10.1161/CIRCIMAGING.109.897439. Epub 2010 Mar 26.

DOI:10.1161/CIRCIMAGING.109.897439

PMID:20348438

Abstract

BACKGROUND

Microvascular obstruction (MO) is associated with large acute myocardial infarction and lower left ventricular (LV) ejection fraction and predicts greater remodeling, but whether this effect is abolished by contemporary antiremodeling therapies is subject to debate. We examined the influence of several infarct characteristics, including MO, on LV remodeling in an optimally treated post-acute myocardial infarction cohort, using contrast-enhanced cardiac magnetic resonance.

METHODS AND RESULTS

One hundred patients (mean age, 58.9+/-12 years, 77%men) underwent contrast-enhanced cardiac magnetic resonance at baseline (approximately 4 days) and at 12 and 24 weeks. The effects on LV remodeling (ie, change in LV end-systolic volume index [DeltaLVESVi]) of infarct site, transmurality, endocardial extent, and the presence of early and late MO were analyzed. Mean baseline infarct volume index decreased from 34.0 (21.2) mL/m(2) to 20.9 (12.9) mL/m(2) at 24 weeks (P<0.001). Infarct site had no influence on remodeling, but greater baseline infarct transmurality (r=0.47, P<0.001) and endocardial extent (r=0.26, P<0.01) were associated with higher DeltaLVESVi. Early MO was seen in 69 patients (69%) and persisted as late MO in 56 patients (56%). Patients with late MO underwent significantly greater remodeling than those without MO (DeltaLVESVi, +4.1 [13.4] versus -7.0 [12.7] mL/m(2), respectively, P=0.001); those with early MO only displayed an intermediate DeltaLVESVi (-4.9 [13.0] mL/m(2)). Importantly, late MO was seen frequently despite optimal coronary blood flow having been restored at angiography.

CONCLUSIONS

Late MO on predischarge contrast-enhanced cardiac magnetic resonance remains an ominous predictor of adverse LV remodeling despite powerful antiremodeling therapy and may be useful in the risk stratification of survivors of acute myocardial infarction.

摘要

背景

微血管阻塞（MO）与大急性心肌梗死和较低的左心室（LV）射血分数相关，并预测更大的重塑，但这种影响是否被当代抗重塑治疗所消除仍存在争议。我们使用对比增强心脏磁共振检查了急性心肌梗死后最佳治疗的患者队列中几种梗死特征（包括 MO）对 LV 重塑的影响。

方法和结果

100 例患者（平均年龄 58.9±12 岁，77%为男性）在基线（约 4 天）和 12 周和 24 周时进行了对比增强心脏磁共振检查。分析了梗死部位、透壁性、心内膜范围以及早期和晚期 MO 的存在对 LV 重塑（即 LV 收缩末期容积指数变化，DeltaLVESVi）的影响。24 周时，平均基线梗死容积指数从 34.0（21.2）mL/m2 下降至 20.9（12.9）mL/m2（P<0.001）。梗死部位对重塑没有影响，但更大的基线梗死透壁性（r=0.47，P<0.001）和心内膜范围（r=0.26，P<0.01）与更高的 DeltaLVESVi 相关。69 例患者（69%）出现早期 MO，56 例患者（56%）出现晚期 MO。晚期 MO 患者的重塑明显大于无 MO 患者（DeltaLVESVi，分别为+4.1[13.4]和-7.0[12.7]mL/m2，P=0.001）；早期 MO 患者仅表现出中等 DeltaLVESVi（-4.9[13.0]mL/m2）。重要的是，尽管血管造影显示冠状动脉血流已经恢复，但仍经常出现晚期 MO。