Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.
Am J Cardiol. 2014 Jul 15;114(2):243-9. doi: 10.1016/j.amjcard.2014.04.034. Epub 2014 May 2.
We evaluated the relation between reperfusion indexes and right ventricular (RV) dysfunction in patients with inferior ST-segment elevation myocardial infarction (STEMI). We included patients with inferior STEMI undergoing percutaneous coronary intervention and right coronary artery as infarct-related artery. Myocardial reperfusion was evaluated by Thrombolysis In Myocardial Infarction (TIMI) flow, TIMI frame count, myocardial blush grade, and ST-segment resolution. RV dysfunction was defined as tricuspid annular plane systolic excursion≤16 mm in M-mode imaging. RV dysfunction was present in 58 of 141 patients (41.1%) and was more frequent in patients achieving suboptimal postprocedural TIMI flow grade (66.7% vs 36.7%, grades 0 to 2 vs 3, p=0.01), TIMI frame count (63.2% vs 37.7%, ≥40 vs <40 frames, p=0.04), and myocardial blush grade (33.3% vs 56.2%, grade 0 or 1 vs 2 or 3, p=0.001). RV dysfunction rates did not differ according to ST-segment resolution. Patients with RV dysfunction had increased rates of cardiac death (13.2% vs 2.6%, p=0.03), reinfarction (24.5% vs 10.3%, p=0.03), and stent thrombosis (22.6% vs 6.4%, p=0.01) at 2-year follow-up. Postprocedural TIMI flow grade 3 (odds ratio 0.25, 95% confidence interval 0.09 to 0.68, p=0.007) was the only reperfusion correlate of RV dysfunction at multivariate analysis. In an independent cohort of 84 patients with STEMI, postprocedural TIMI flow grade 3 had a limited sensitivity (52%), with a high specificity (74.5%) and negative predictive value (71%) for excluding RV dysfunction. In conclusion, in patients with inferior STEMI undergoing coronary revascularization, RV dysfunction is associated with a worse long-term prognosis. Postprocedural TIMI flow grade may be a useful tool to predict RV dysfunction.
我们评估了再灌注指数与下壁 ST 段抬高型心肌梗死（STEMI）患者右心室（RV）功能障碍之间的关系。我们纳入了接受经皮冠状动脉介入治疗且右冠状动脉为梗死相关动脉的下壁 STEMI 患者。通过心肌梗死溶栓治疗（TIMI）血流、TIMI 帧数、心肌灌注分级和 ST 段回落来评估心肌再灌注。RV 功能障碍定义为 M 型超声心动图上三尖瓣环平面收缩期位移（TAPSE）≤16mm。141 例患者中有 58 例（41.1%）存在 RV 功能障碍，在术后 TIMI 血流分级不理想（66.7%比 36.7%，0-2 级比 3 级，p=0.01）、TIMI 帧数（63.2%比 37.7%，≥40 帧比<40 帧，p=0.04）和心肌灌注分级（33.3%比 56.2%，0 或 1 级比 2 或 3 级，p=0.001）的患者中更为常见。根据 ST 段回落，RV 功能障碍的发生率没有差异。RV 功能障碍患者的心脏死亡（13.2%比 2.6%，p=0.03）、再梗死（24.5%比 10.3%，p=0.03）和支架血栓形成（22.6%比 6.4%，p=0.01）发生率在 2 年随访时更高。多变量分析显示，术后 TIMI 血流分级 3 级（比值比 0.25，95%置信区间 0.09 至 0.68，p=0.007）是唯一与 RV 功能障碍相关的再灌注指标。在另一项 84 例 STEMI 患者的独立队列中，术后 TIMI 血流分级 3 级的敏感性有限（52%），特异性（74.5%）和阴性预测值（71%）较高，可排除 RV 功能障碍。结论：在接受冠状动脉血运重建的下壁 STEMI 患者中，RV 功能障碍与预后不良相关。术后 TIMI 血流分级可能是预测 RV 功能障碍的有用工具。
