Fabregat-Andrés Óscar, Cubillos Andrés, Ferrando-Beltrán Mónica, Bochard-Villanueva Bruno, Estornell-Erill Jordi, Fácila Lorenzo, Ridocci-Soriano Francisco, Morell Salvador
Cardiology Department, Hospital General Universitario de Valencia, Valencia, Spain.
Blood Coagul Fibrinolysis. 2013 Jun;24(4):424-7. doi: 10.1097/MBC.0b013e32835d9bca.
Mean platelet volume (MPV) is an indicator of platelet activation. High MPV has been recently considered as an independent risk factor for poor outcomes after ST-segment elevation myocardial infarction (STEMI). We analyzed 128 patients diagnosed with first STEMI successfully reperfused during three consecutive years. MPV was measured on admission and a cardiac magnetic resonance (CMR) exam was performed within the first week in all patients. Myocardial necrosis size was estimated by the area of late gadolinium enhancement (LGE), identifying microvascular obstruction (MVO), if present. Clinical outcomes were recorded at 1 year follow-up. High MPV was defined as a value in the third tertile (≥9.5 fl), and a low MPV, as a value in the lower two. We found a slight but significant correlation between MPV and infarct size (r = 0.287, P = 0.008). Patients with high MPV had more extensive infarcted area (percentage of necrosis by LGE: 17.6 vs. 12.5%, P = 0.021) and more presence of MVO (patients with MVO pattern: 44.4 vs. 25.3%, P = 0.027). In a multivariable analysis, hazard ratio for major adverse cardiac events was 3.35 [95% confidence interval (CI) 1.1-9.9, P = 0.03] in patients with high MPV. High MPV in patients with first STEMI is associated with higher infarct size and more presence of MVO measured by CMR.
平均血小板体积（MPV）是血小板活化的一个指标。近期，高MPV已被视为ST段抬高型心肌梗死（STEMI）后预后不良的独立危险因素。我们分析了连续三年中成功再灌注的128例首次诊断为STEMI的患者。所有患者入院时均测量了MPV，并在第一周内进行了心脏磁共振（CMR）检查。通过钆延迟强化（LGE）面积估算心肌坏死大小，若存在则识别微血管阻塞（MVO）。在1年随访时记录临床结局。高MPV定义为处于第三个三分位数的值（≥9.5 fl），低MPV定义为处于较低两个三分位数的值。我们发现MPV与梗死面积之间存在轻微但显著的相关性（r = 0.287，P = 0.008）。高MPV患者的梗死面积更大（LGE坏死百分比：17.6%对12.5%，P = 0.021），且MVO的存在更多（有MVO模式的患者：44.4%对25.3%，P = 0.027）。在多变量分析中，高MPV患者发生主要不良心脏事件的风险比为3.35 [95%置信区间（CI）1.1 - 9.9，P = 0.03]。首次STEMI患者的高MPV与通过CMR测量的更大梗死面积和更多MVO存在相关。
