Internal Medicine Department, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil.
Nutrition. 2013 Jan;29(1):122-6. doi: 10.1016/j.nut.2012.04.020. Epub 2012 Sep 6.
The impact of obesity on ventricular remodeling after myocardial infarction (MI) is still poorly understood. Therefore, the aim of this study was to evaluate the role of waist circumference (WC) and body mass index as predictors of cardiac remodeling in patients after an anterior MI.
Eighty-three consecutive patients with anterior MI were prospectively evaluated. Clinical characteristics and echocardiographic data were analyzed at admission and at a 6-mo follow-up. Ventricular remodeling was defined as a 10% increase in left ventricular end-systolic or end-diastolic diameter at the 6-mo follow-up.
In our study, 83 consecutive patients were evaluated (72% men). Ventricular remodeling was present in 31% of the patients (77% men). Patients with remodeling had higher creatine phosphokinase and creatine phosphokinase-MB peak values, a higher resting heart rate, a larger left atrial diameter, and a larger interventricular septum diastolic thickness. In addition, patients with remodeling had lower peak velocity of early ventricular filling deceleration time and ejection fraction. Patients with remodeling presented higher WC values (with remodeling, 99.2 ± 10.4 cm; without remodeling, 93.9 ± 10.8 cm, P = 0.04), but there were no differences in the body mass index values. In the logistic regression analysis, WC, adjusted by age, gender, ejection fraction, and creatine phosphokinase levels, was an independent predictor of left ventricular remodeling (odds ratio 1.067, 95% confidence interval 1.001-1.129, P = 0.02).
Waist circumference, but not body mass index, is a predictor of ventricular remodeling after an anterior MI. Therefore, the WC of these patients should be measured in clinical practice.
肥胖对心肌梗死后心室重构的影响仍不清楚。因此，本研究旨在评估腰围（WC）和体重指数作为预测前壁心肌梗死后心脏重构的指标。
前瞻性评估 83 例连续前壁心肌梗死患者。入院时和 6 个月随访时分析临床特征和超声心动图数据。心室重构定义为 6 个月随访时左心室收缩末期或舒张末期直径增加 10%。
本研究共评估了 83 例连续患者（72%为男性）。31%的患者存在心室重构（77%为男性）。有重构的患者肌酸激酶和肌酸激酶同工酶峰值较高，静息心率较高，左心房直径较大，室间隔舒张期厚度较大。此外，有重构的患者早期心室充盈减速时间和射血分数峰值较低。有重构的患者 WC 值较高（有重构者为 99.2±10.4cm；无重构者为 93.9±10.8cm，P=0.04），但体重指数值无差异。在逻辑回归分析中，WC 经年龄、性别、射血分数和肌酸激酶水平调整后，是左心室重构的独立预测因子（比值比 1.067，95%置信区间 1.001-1.129，P=0.02）。
WC 而不是 BMI 是前壁心肌梗死后心室重构的预测指标。因此，在临床实践中应测量这些患者的 WC。
