Arı Hatem, Sonmez Osman, Koc Fatih, Alıhanoglu Yusuf, Ozdemır Kurtulus, Vatankulu Mehmet Akif
Suleyman Demirel University, Faculty of Medicine, Cardiology Department, Isparta/Turkey.
Bezmialem Vakif University, Faculty of Medicine, Cardiology Department, Istanbul/Turkey.
Heart Lung Circ. 2016 Mar;25(3):250-6. doi: 10.1016/j.hlc.2015.06.833. Epub 2015 Sep 28.
We aimed to investigate the circadian rhythm on left ventricular (LV) function and infarct size, according to the onset of ST elevation myocardial infarction (STEMI), with echocardiography in patients with first STEMI successfully revascularised with primary percutaneous coronary intervention (PCI).
We conducted a retrospective analysis of 252 STEMI patients. Patients were divided into the four, six-hour periods of the day. Conventional and tissue Doppler imaging (TDI) echocardiography were performed within 48hours after onset of chest pain. The average of peak systolic myocardial velocities (Sm) in each of the four myocardial segments and LV ejection fraction (LVEF) were calculated.
A negative linear correlation was shown between CK-MB levels and Sm (r= -0.209, p=0.001). There was an oscillation between time of day and average of Sm. The lowest Sm and largest infarct size were in the period of 06:00-noon compared with period of noon-18:00 and 18:00-midnight (p=0.029 and p=0.031, respectively). A secondary analysis showed that both LVEF and Sm were lower in the midnight-noon group compared with the noon-midnight group (44.9±7.3% versus 47.3±7.9%, p=0.018, and 7.6±1.4cm/s versus 8.2±1.6cm/s, p=0.003, respectively).
This study has shown that there was a circadian rhythm of infarct size and LV function evaluated by echocardiography according to time of STEMI onset. The largest infarct size and poor LV function occurred in the midnight-noon period, in particular in the 06:00-noon period.
我们旨在通过超声心动图研究首次ST段抬高型心肌梗死（STEMI）患者在成功接受直接经皮冠状动脉介入治疗（PCI）实现血管再通后，根据STEMI发病时间，左心室（LV）功能和梗死面积的昼夜节律。
我们对252例STEMI患者进行了回顾性分析。患者被分为一天中的四个六小时时间段。在胸痛发作后48小时内进行常规和组织多普勒成像（TDI）超声心动图检查。计算四个心肌节段中每个节段的收缩期心肌峰值速度（Sm）平均值和左心室射血分数（LVEF）。
CK-MB水平与Sm之间呈负线性相关（r = -0.209，p = 0.001）。一天中的时间与Sm平均值之间存在波动。与中午18:00至午夜时段相比，Sm最低且梗死面积最大的时段是06:00至中午（分别为p = 0.029和p = 0.031）。二次分析显示，与中午至午夜组相比，午夜至中午组的LVEF和Sm均较低（分别为44.9±7.3%对47.3±7.9%，p = 0.018；7.6±1.4cm/s对8.2±1.6cm/s，p = 0.003）。
本研究表明，根据STEMI发病时间，通过超声心动图评估的梗死面积和LV功能存在昼夜节律。梗死面积最大且LV功能较差发生在午夜至中午时段，尤其是06:00至中午时段。
