Gorter Thomas M, Lexis Chris P H, Hummel Yoran M, Lipsic Erik, Nijveldt Robin, Willems Tineke P, van der Horst Iwan C C, van der Harst Pim, van Melle Joost P, van Veldhuisen Dirk J
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Am J Cardiol. 2016 Aug 1;118(3):338-44. doi: 10.1016/j.amjcard.2016.05.006. Epub 2016 May 14.
Right ventricular (RV) dysfunction is a powerful risk marker after acute myocardial infarction (MI). Primary percutaneous coronary intervention (PCI) has markedly reduced myocardial damage of the left ventricle, but reliable data on RV damage using cardiac magnetic resonance imaging (MRI) are scarce. In a recent trial of patients with acute MI treated with primary PCI, in which the primary end point was left ventricular (LV) ejection fraction after 4 months measured with MRI, we conducted a prospectively defined substudy in which we examined RV function. RV ejection fraction (RVEF) and RV scar size were measured with MRI at 4 months. Tricuspid annular plane systolic excursion (TAPSE) and RV free wall longitudinal strain (FWLS) were assessed using echocardiography before discharge and at 4 months. We studied 258 patients without diabetes mellitus; their mean age was 58 ± 11 years, 79% men and mean LV ejection fraction was 54 ± 8%. Before discharge, 5.2% of patients had TAPSE <17 mm, 32% had FWLS > -20% and 11% had FWLS > -15%. During 4 months, TAPSE increased from 22.8 ± 3.6 to 25.1 ± 3.9 mm (p <0.001) and FWLS increased from -22.6 ± 5.8 to -25.9 ± 4.7% (p <0.001). After 4 months, mean RVEF on MRI was 64.1 ± 5.2% and RV scar was detected in 5 patients (2%). There was no correlation between LV scar size and RVEF (p = 0.9), TAPSE (p = 0.1), or RV FWLS (p = 0.9). In conclusion, RV dysfunction is reversible in most patients and permanent RV ischemic injury is very uncommon 4 months after acute MI treated with primary PCI.
右心室（RV）功能障碍是急性心肌梗死（MI）后一个强有力的风险标志物。直接经皮冠状动脉介入治疗（PCI）显著减少了左心室的心肌损伤，但关于使用心脏磁共振成像（MRI）评估右心室损伤的可靠数据却很匮乏。在一项近期针对接受直接PCI治疗的急性MI患者的试验中，其主要终点是4个月后用MRI测量的左心室（LV）射血分数，我们进行了一项预先设定的亚研究，其中我们检查了右心室功能。在4个月时用MRI测量右心室射血分数（RVEF）和右心室瘢痕大小。在出院前和4个月时使用超声心动图评估三尖瓣环平面收缩期位移（TAPSE）和右心室游离壁纵向应变（FWLS）。我们研究了258例无糖尿病患者；他们的平均年龄为58±11岁，79%为男性，平均左心室射血分数为54±8%。出院前，5.2%的患者TAPSE<17mm，32%的患者FWLS>-20%，11%的患者FWLS>-15%。在4个月期间，TAPSE从22.8±3.6mm增加到25.1±3.9mm（p<0.001），FWLS从-22.6±5.8%增加到-25.9±4.7%（p<0.001）。4个月后，MRI上的平均RVEF为64.1±5.2%，5例患者（2%）检测到右心室瘢痕。左心室瘢痕大小与RVEF（p=0.9）、TAPSE（p=0.1）或右心室FWLS（p=0.9）之间无相关性。总之，在大多数患者中右心室功能障碍是可逆的，在接受直接PCI治疗的急性MI后4个月，永久性右心室缺血性损伤非常罕见。
