Division of Cardiology, Careggi Hospital, Largo Brambilla 3, 50141, Florence, Italy,
Basic Res Cardiol. 2014 Jul;109(4):412. doi: 10.1007/s00395-014-0412-2. Epub 2014 May 14.
Doxycycline has been demonstrated to reduced left ventricular (LV) remodeling, but its effect in patients with ST-elevation myocardial infarction (STEMI) and a baseline occluded [thrombolysis in myocardial infarction (TIMI) flow grade ≤1] infarct-related artery (IRA) is unknown. According to the baseline TIMI flow grade, 110 patients with a first STEMI were divided into 2 groups. Group 1: 77 patients with TIMI flow ≤1 (40 patients treated with doxycycline and 37 with standard therapy, respectively), and a Group 2: 33 patients with TIMI flow 2-3 (15 patients treated with doxycycline and 18 with standard therapy, respectively). The two randomized groups were well matched in baseline characteristics. A 2D-Echo was performed at baseline and at 6 months, together with a coronary angiography, for the remodeling and IRA patency assessment, respectively. The LV end-diastolic volume index (LVEDVi) decreased in Group 2 [-3 mL/m(2) (IQR: -12 to 4 mL/m(2))], and increased in Group 1 [6 mL/m(2) (IQR: -2 to 14 mL/m(2))], (p = 0.001). In Group 2, LVEDVi reduction was similar regardless of drug therapy, while in Group 1 the LVEDVi was smaller in patients treated with doxycycline as compared to control [3 mL/m(2) (IQR: -3 to 8 mL/m(2)) vs. 10 mL/m(2) (IQR: 1-27 mL/m(2)), p = 0.006]. A similar pattern was observed also for LV end-systolic volume and ejection fraction. In STEMI patients at higher risk, as those with a baseline TIMI flow grade ≤1, doxycycline reduces LV remodeling.
多西环素已被证明可减少左心室（LV）重构，但它对 ST 段抬高型心肌梗死（STEMI）和基线闭塞[心肌梗死溶栓治疗（TIMI）血流分级≤1]相关梗死动脉（IRA）患者的影响尚不清楚。根据基线 TIMI 血流分级，将 110 例首次发生 STEMI 的患者分为 2 组。第 1 组：77 例 TIMI 血流≤1（40 例接受多西环素治疗，37 例接受标准治疗）；第 2 组：33 例 TIMI 血流 2-3（15 例接受多西环素治疗，18 例接受标准治疗）。两组随机分组的患者在基线特征方面具有可比性。两组患者均于基线时和 6 个月时分别进行二维超声心动图检查和冠状动脉造影，以评估 LV 重构和 IRA 通畅情况。第 2 组 LV 舒张末期容积指数（LVEDVi）降低[-3 mL/m2（IQR：-12 至 4 mL/m2）]，第 1 组增加[6 mL/m2（IQR：-2 至 14 mL/m2）]，（p = 0.001）。第 2 组无论药物治疗如何，LVEDVi 降低均相似，而第 1 组多西环素治疗的患者与对照组相比，LVEDVi 更小[3 mL/m2（IQR：-3 至 8 mL/m2）比 10 mL/m2（IQR：1 至 27 mL/m2）]，（p = 0.006）。LV 收缩末期容积和射血分数也呈现类似的模式。在基线 TIMI 血流分级≤1 的高危 STEMI 患者中，多西环素可减少 LV 重构。
