Grover Suchi, Bell Gregory, Lincoff Michael, Jeorg Lucas, Madsen Per Lav, Huang Saling, Leow Sean, Figtree Gemma, Chakrabarty Adhiraj, Leong Darryl P, Woodman Richard J, Selvanayagam Joseph B
Flinders University, Adelaide, SA, Australia; Cardiology Department, Flinders Medical Centre, Adelaide, SA Austrlaia; Cardiac Imaging Research Centre, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
KAI Pharmaceuticals Inc, San Francisco, CAL, USA.
Heart Lung Circ. 2015 Sep;24(9):891-7. doi: 10.1016/j.hlc.2015.03.001. Epub 2015 Mar 24.
Adverse left ventricular (LV) remodelling following acute ST-segment elevation myocardial infarction (STEMI) has prognostic importance. We aimed to predict 90-day left ventricular (LV) function following acute STEMI using variables from clinical presentation, biomarkers, and cardiovascular magnetic resonance imaging (CMR).
Consecutive patients undergoing primary percutaneous coronary intervention for anterior STEMI as part of the Selective Inhibition of Delta-protein Kinase C for the Reduction of Infarct Size in Acute Myocardial Infarction (PROTECTION-AMI) trial were enrolled into the CMR sub-study at selected sites. CMR was performed at baseline (days 3 to 5) and 90 days and used to evaluate infarct size, myocardial salvage index, infarct heterogeneity, microvascular obstruction and global LV function. Biochemical markers including creatinine kinase area under the curve (CK AUC), peak CK, peak CK-myocardial band (CK-MB) and AUC, and troponin I were collected at specific time-points.
Ninety-six patients were enrolled in the CMR sub study and 85 completed the 90-day follow-up, across 24 centres worldwide. LV ejection fraction (EF) was 56% (46-63%) at baseline and 60% (49-67%) at 90 days (p<0.001). Infarct size had moderate inverse correlation with 90-day EF (Spearman's rho=-0.7, p < 0.001) and had the strongest correlation when compared to myocardial salvage index (Spearman's rho=0.5, p=0.001), infarct heterogeneity (Spearman's rho=-0.4, p=0.02 or microvascular obstruction (Spearman's rho=-0.4, p<0.001). All biochemical markers had similar moderate relationship to LVEF at 90 days (Spearman's rho -0.6 to -0.8, p=0.001). In a multivariable model, only baseline LVEF, CMR infarct size and infarct heterogeneity independently predicted 90-day LVEF.
This study reports findings of a combined CMR protocol (including myocardial oedema imaging) in a multi-centre, multi-vendor setting. We found infarct size, infarct heterogeneity and myocardial salvage index correlated favourably with 90-day LVEF, however only the former two were independently predictive.
急性ST段抬高型心肌梗死（STEMI）后左心室（LV）不良重构具有预后意义。我们旨在利用临床表现、生物标志物和心血管磁共振成像（CMR）的变量预测急性STEMI后90天的左心室（LV）功能。
作为急性心肌梗死中Delta蛋白激酶C选择性抑制以减少梗死面积（PROTECTION-AMI）试验的一部分，连续接受前壁STEMI直接经皮冠状动脉介入治疗的患者在选定地点纳入CMR子研究。在基线（第3至5天）和90天时进行CMR，用于评估梗死面积、心肌挽救指数、梗死异质性、微血管阻塞和整体LV功能。在特定时间点收集包括肌酸激酶曲线下面积（CK AUC）、峰值CK、峰值CK-心肌带（CK-MB）及其AUC以及肌钙蛋白I在内的生化标志物。
全球24个中心共有96例患者纳入CMR子研究，85例完成了90天随访。基线时左心室射血分数（EF）为56%（46-63%），90天时为60%（49-67%）（p<0.001）。梗死面积与90天EF呈中度负相关（Spearman秩相关系数=-0.7，p<0.001），与心肌挽救指数（Spearman秩相关系数=0.5，p=0.001）、梗死异质性（Spearman秩相关系数=-0.4，p=0.02）或微血管阻塞（Spearman秩相关系数=-0.4，p<0.001）相比，相关性最强。所有生化标志物与90天时的左心室射血分数均具有相似的中度关系（Spearman秩相关系数-0.6至-0.8，p=0.001）。在多变量模型中，只有基线左心室射血分数、CMR梗死面积和梗死异质性可独立预测90天左心室射血分数。
本研究报告了在多中心、多供应商环境下联合CMR方案（包括心肌水肿成像）的研究结果。我们发现梗死面积、梗死异质性和心肌挽救指数与90天左心室射血分数呈良好相关性，但只有前两者具有独立预测性。
