Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
Kardiol Pol. 2012;70(4):329-40.
Post-ST-segment elevation myocardial infarction (STEMI) left ventricular systolic dysfunction (LVSD) has been identified as an important marker of poor prognosis.
To assess the prevalence and course of LVSD at hospital discharge and in long-term follow-up in STEMI patients treated with primary percutaneous coronary intervention (pPCI).
We enrolled 205 patients (157 male, 48 female) with a first STEMI. Echocardiography was performed before hospital discharge and 12 months after STEMI. Left ventricular systolic function (LVSF) parameters were assessed: left ventricular ejection fraction (LVEF), wall motion score index (WMSI), and average peak systolic mitral annular velocity (S') by tissue Doppler echocardiography (TDE). B-type natriuretic peptide plasma concentration was measured at admission (BNP(admission)) and at discharge (BNP(discharge)).
We found moderate LVSD, both at hospital discharge and after 12 months. Significant global LVSD (LVEF ≤ 40%) was observed in 34% of patients at discharge, and 21% after 12 months (p 〈 0.001). Significant regional LVSD (WMSI ≥ 1.7) after 12 months was less frequent than at discharge (21% vs 33%; p 〈 0.001). More patients had significant longitudinal LVSD (S' ≤ 6.0 cm/s) after 12 months compared to discharge (28% vs 23%; p 〈 0.001). Severe global LVSD (LVEF ≤ 30%) was rare. Univariate logistic regression analysis revealed the predictors of significant global LVSD at 12 months after STEMI to be: anterior location of STEMI; pre-discharge echocardiographic parameters of LVSF and left ventricle size and mass; prepPCI angiographic indices; ratio of the difference of BNP(discharge) and BNPa(dmission) to BNP(admission) expressed as % (BNP(delta) %); time from onset of pain to balloon, and the use of abciximab. Multivariate logistic regression analysis found independent predictors of significant global LVSD at 12 months to be: BNP(delta) % and LVEF at discharge with optimal cut-off values of 728.2% for BNP(delta) % and 37% for LVEF.
Patients with a first STEMI treated with pPCI present moderate LVSD, both at hospital discharge and after 12 months. In long-term follow-up, we found an improvement in global LVSF, and, albeit a smaller, improvement in regional LVSF. No improvement in longitudinal LVSF was observed. The increase of BNP during hospitalisation, and LVEF at discharge, are independent predictors of significant global LVSD at 12 months after a first STEMI treated with pPCI. Pre-discharge peak systolic mitral annular velocity obtained by TDE may be useful in predicting LVEF in long-term follow-up in this group of patients.
ST 段抬高型心肌梗死（STEMI）后左心室收缩功能障碍（LVSD）已被确定为预后不良的重要标志物。
评估接受直接经皮冠状动脉介入治疗（pPCI）的 STEMI 患者在出院时和长期随访中的 LVSD 发生率和病程。
我们纳入了 205 例首次发生 STEMI 的患者（男 157 例，女 48 例）。在出院前和 STEMI 后 12 个月进行超声心动图检查。使用组织多普勒超声心动图（TDE）评估左心室收缩功能（LVSF）参数：左心室射血分数（LVEF）、壁运动评分指数（WMSI）和平均收缩期二尖瓣环速度峰值（S'）。在入院时（BNP(admission))和出院时（BNP(discharge))测量 B 型利钠肽血浆浓度。
我们发现，患者在出院时和 12 个月时均存在中度 LVSD。出院时，34%的患者存在明显的整体 LVSD（LVEF ≤ 40%），12 个月后为 21%（p 〈 0.001）。12 个月后观察到的明显区域性 LVSD（WMSI ≥ 1.7）较出院时少见（21%比 33%；p 〈 0.001）。与出院时相比，12 个月后更多患者存在明显的纵向 LVSD（S' ≤ 6.0 cm/s）（28%比 23%；p 〈 0.001）。严重的整体 LVSD（LVEF ≤ 30%）较为罕见。单因素逻辑回归分析显示，STEMI 后 12 个月时出现明显整体 LVSD 的预测因子为：STEMI 的前壁位置；出院时的 LVSF 和左心室大小和质量的超声心动图参数；pPCI 血管造影指数；以百分比表示的 BNP（差值）/BNP（入院）比值（BNP(delta) %）；疼痛发作至球囊的时间和使用替罗非班。多因素逻辑回归分析发现，STEMI 后 12 个月时出现明显整体 LVSD 的独立预测因子为：BNP(delta) %和出院时的 LVEF，BNP(delta) %的最佳截断值为 728.2%，LVEF 的最佳截断值为 37%。
接受 pPCI 治疗的首次发生 STEMI 的患者在出院时和 12 个月时均存在中度 LVSD。在长期随访中，我们发现整体 LVSF 有所改善，区域性 LVSF 虽然较小，但也有所改善。纵向 LVSF 未见改善。住院期间 BNP 的增加和出院时的 LVEF 是 STEMI 后 12 个月时出现明显整体 LVSD 的独立预测因子。直接经皮冠状动脉介入治疗后，通过 TDE 获得的收缩期二尖瓣环速度峰值可能有助于预测该组患者的长期随访中的 LVEF。
