在接受直接经皮冠状动脉介入治疗的ST段抬高型心肌梗死患者中，左心室肥厚与梗死面积增加及心肌挽救率降低相关。
Left Ventricular Hypertrophy Is Associated With Increased Infarct Size and Decreased Myocardial Salvage in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.
作者信息
Nepper-Christensen Lars, Lønborg Jacob, Ahtarovski Kiril Aleksov, Høfsten Dan Eik, Kyhl Kasper, Ghotbi Adam Ali, Schoos Mikkel Malby, Göransson Christoffer, Bertelsen Litten, Køber Lars, Helqvist Steffen, Pedersen Frants, Saünamaki Kari, Jørgensen Erik, Kelbæk Henning, Holmvang Lene, Vejlstrup Niels, Engstrøm Thomas
机构信息
Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
出版信息
J Am Heart Assoc. 2017 Jan 9;6(1):e004823. doi: 10.1161/JAHA.116.004823.
BACKGROUND
Approximately one third of patients with ST-segment elevation myocardial infarction (STEMI) have left ventricular hypertrophy (LVH), which is associated with impaired outcome. However, the causal association between LVH and outcome in STEMI is unknown. We evaluated the association between LVH and: myocardial infarct size, area at risk, myocardial salvage, microvascular obstruction, left ventricular (LV) function (all determined by cardiac magnetic resonance [CMR]), and all-cause mortality and readmission for heart failure in STEMI patients treated with primary percutaneous coronary intervention.
METHODS AND RESULTS
In this substudy of the DANAMI-3 trial, 764 patients underwent CMR. LVH was defined by CMR and considered present if LV mass exceeded 77 (men) and 67 g/m (women). One hundred seventy-eight patients (24%) had LVH. LVH was associated with a larger final infarct size (15% [interquartile range {IQR}, 10-21] vs 9% [IQR, 3-17]; P<0.001) and smaller final myocardial salvage index (0.6 [IQR, 0.5-0.7] vs 0.7 [IQR, 0.5-0.9]; P<0.001). The LVH group had a higher incidence of microvascular obstruction (66% vs 45%; P<0.001) and lower final LV ejection fraction (LVEF; 53% [IQR, 47-60] vs 61% [IQR, 55-65]; P<0.001). In a Cox regression analysis, LVH was associated with a higher risk of all-cause mortality and readmission for heart failure (hazard ratio 2.59 [95% CI, 1.38-4.90], P=0.003). The results remained statistically significant in multivariable models.
CONCLUSIONS
LVH is independently associated with larger infarct size, less myocardial salvage, higher incidence of microvascular obstruction, lower LVEF, and a higher risk of all-cause mortality and incidence of heart failure in STEMI patients treated with primary percutaneous coronary intervention.
CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01435408.
背景
约三分之一的ST段抬高型心肌梗死（STEMI）患者存在左心室肥厚（LVH），这与预后不良相关。然而，STEMI患者中LVH与预后之间的因果关系尚不清楚。我们评估了LVH与以下因素之间的关联：心肌梗死面积、危险区域面积、心肌挽救、微血管阻塞、左心室（LV）功能（均通过心脏磁共振成像[CMR]测定），以及接受直接经皮冠状动脉介入治疗的STEMI患者的全因死亡率和心力衰竭再入院率。
方法与结果
在DANAMI - 3试验的这项子研究中，764例患者接受了CMR检查。LVH通过CMR定义，若男性左心室质量超过77g，女性超过67g/m²，则认为存在LVH。178例患者（24%）存在LVH。LVH与更大的最终梗死面积相关（15%[四分位间距{IQR}，10 - 21] vs 9%[IQR，3 - 17]；P<0.001），且最终心肌挽救指数更小（0.6[IQR，0.5 - 0.7] vs 0.7[IQR，0.5 - 0.9]；P<0.001）。LVH组微血管阻塞发生率更高（66% vs 45%；P<0.001），最终左心室射血分数（LVEF）更低（53%[IQR，47 - 60] vs 61%[IQR，55 - 65]；P<0.001）。在Cox回归分析中，LVH与全因死亡率和心力衰竭再入院风险更高相关（风险比2.59[95%CI，1.38 - 4.90]，P = 0.003）。在多变量模型中，结果仍具有统计学意义。
结论
在接受直接经皮冠状动脉介入治疗的STEMI患者中，LVH独立地与更大的梗死面积、更少的心肌挽救、更高的微血管阻塞发生率、更低的LVEF，以及更高的全因死亡率和心力衰竭发生率相关。
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