Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
JACC Cardiovasc Interv. 2013 Oct;6(10):1046-54. doi: 10.1016/j.jcin.2013.05.014.
This study sought to investigate the relationship between the degree of microvascular dysfunction assessed by a dual-sensor guidewire (pressure and Doppler velocity) and left ventricular (LV) remodeling after successful primary percutaneous coronary intervention (PPCI) for a first anterior acute myocardial infarction (AMI).
Microvascular dysfunction after AMI is associated with progressive LV dilation.
In 24 consecutive patients, the microvascular resistance index (MVRI) immediately after PPCI was calculated as the ratio of the mean distal pressure to average peak flow velocity during maximal hyperemia. Cardiac magnetic resonance was performed to determine LV volumes at baseline and 8-month follow-up. LV remodeling was defined as an increase in left ventricular end-diastolic volume (LVEDV) of ≥20%.
In patients with an MVRI greater than the median value of 2.96 mm Hg·cm(-1)·s, the LVEDV increased significantly from 117.1 ± 20.7 ml at baseline to 146.5 ± 21.4 ml (p = 0.006) at 8 months, whereas it did not change between baseline and 8 months (108.2 ± 21.2 ml vs. 111.6 ± 29.9 ml, p = 0.620) in patients with an MVRI ≤2.96 mm Hg·cm(-1)·s. LV remodeling was more frequent in the group with an MVRI >2.96 mm Hg·cm(-1)·s (64% vs. 15%, p = 0.033). Furthermore, there was a positive correlation between MVRI and the percentage of increase or decrease in LVEDV (r = 0.42, p = 0.042). Logistic regression analysis showed that MVRI was the strongest univariate predictor of LV remodeling. The best cutoff value of MVRI was 2.96 mm Hg·cm(-1)·s with a sensitivity of 78% and a specificity of 73%.
MVRI immediately after PPCI predicts LV remodeling in patients with reperfused anterior AMI.
本研究旨在探讨通过双传感器导丝（压力和多普勒速度）评估的微血管功能障碍程度与首次前壁急性心肌梗死（AMI）经皮冠状动脉介入治疗（PPCI）成功后左心室（LV）重构之间的关系。
AMI 后微血管功能障碍与 LV 进行性扩张有关。
在 24 例连续患者中，在 PPCI 后立即计算微血管阻力指数（MVRI），方法是将平均远端压力与最大充血期间平均峰值血流速度的比值作为微血管阻力指数（MVRI）。进行心脏磁共振检查以确定基线和 8 个月随访时的 LV 容积。LV 重构定义为左心室舒张末期容积（LVEDV）增加≥20%。
在 MVRI 大于中位数 2.96mm Hg·cm(-1)·s 的患者中，LVEDV 从基线时的 117.1±20.7ml 显著增加到 8 个月时的 146.5±21.4ml（p=0.006），而在 MVRI≤2.96mm Hg·cm(-1)·s 的患者中，基线与 8 个月之间的 LVEDV 无变化（108.2±21.2ml 与 111.6±29.9ml，p=0.620）。MVRI＞2.96mm Hg·cm(-1)·s 的患者中，LV 重构更为常见（64%比 15%，p=0.033）。此外，MVRI 与 LVEDV 增加或减少的百分比之间存在正相关（r=0.42，p=0.042）。逻辑回归分析显示，MVRI 是 LV 重构的最强单变量预测因子。MVRI 的最佳截断值为 2.96mm Hg·cm(-1)·s，灵敏度为 78%，特异性为 73%。
PPCI 后即刻 MVRI 可预测再灌注前壁 AMI 患者的 LV 重构。
