Minicucci Marcos F, Farah Elaine, Fusco Daniéliso R, Cogni Ana Lúcia, Azevedo Paula S, Okoshi Katashi, Zanati Silméia G, Matsubara Beatriz B, Paiva Sergio A R, Zornoff Leonardo A M
Arq Bras Cardiol. 2014 Jun;102(6):549-56. doi: 10.5935/abc.20140051. Epub 2014 May 9.
The effects of modern therapy on functional recovery after acute myocardial infarction (AMI) are unknown.
To evaluate the predictors of systolic functional recovery after anterior wall AMI in patients undergoing modern therapy (reperfusion, aggressive platelet antiaggregant therapy, angiotensin-converting enzyme inhibitors and beta-blockers).
A total of 94 consecutive patients with AMI with ST-segment elevation were enrolled. Echocardiograms were performed during the in-hospital phase and after 6 months. Systolic dysfunction was defined as ejection fraction value < 50%.
In the initial echocardiogram, 64% of patients had systolic dysfunction. Patients with ventricular dysfunction had greater infarct size, assessed by the measurement of total and isoenzyme MB creatine kinase enzymes, than patients without dysfunction. Additionally, 24.5% of patients that initially had systolic dysfunction showed recovery within 6 months after AMI. Patients who recovered ventricular function had smaller infarct sizes, but larger values of ejection fraction and E-wave deceleration time than patients without recovery. At the multivariate analysis, it can be observed that infarct size was the only independent predictor of functional recovery after 6 months of AMI when adjusted for age, gender, ejection fraction and E-wave deceleration time.
In spite of aggressive treatment, systolic ventricular dysfunction remains a frequent event after the anterior wall myocardial infarction. Additionally, 25% of patients show functional recovery. Finally, infarct size was the only significant predictor of functional recovery after six months of acute myocardial infarction.
现代治疗对急性心肌梗死（AMI）后功能恢复的影响尚不清楚。
评估接受现代治疗（再灌注、积极的血小板抗聚集治疗、血管紧张素转换酶抑制剂和β受体阻滞剂）的前壁AMI患者收缩功能恢复的预测因素。
连续纳入94例ST段抬高型AMI患者。在住院期间和6个月后进行超声心动图检查。收缩功能障碍定义为射血分数值<50%。
在初始超声心动图检查中，64%的患者存在收缩功能障碍。通过测量总肌酸激酶和肌酸激酶同工酶MB评估，心室功能障碍患者的梗死面积大于无功能障碍患者。此外，最初有收缩功能障碍的患者中有24.5%在AMI后6个月内出现恢复。恢复心室功能的患者梗死面积较小，但射血分数和E波减速时间值大于未恢复的患者。在多变量分析中，可以观察到，在调整年龄、性别、射血分数和E波减速时间后，梗死面积是AMI 6个月后功能恢复的唯一独立预测因素。
尽管进行了积极治疗，但前壁心肌梗死后收缩性心室功能障碍仍然是常见事件。此外，25%的患者显示功能恢复。最后，梗死面积是急性心肌梗死6个月后功能恢复的唯一重要预测因素。
