Altıntaş B, Yaylak B, Ede H, Altındağ R, Baysal E, Bilge Ö, Çiftçi H, Adıyaman M Ş, Karahan M Z, Kaya I, Çevik K
Department of Cardiology, Diyabakır Gazi Yaşargil Research and Education Hospital, Peyas Mahallesi, Selahaddin Eyubbi Bulvarı, 229. Sokak Hamzaoğulları Sitesi B/20 Kayapınar, 21070, Diyarbakır, Turkey.
Department Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey.
Herz. 2019 Apr;44(2):155-160. doi: 10.1007/s00059-017-4631-9. Epub 2017 Oct 9.
The aim of this study was to investigate the prognostic value of restrictive right ventricular filling pattern (RRVFP) in patients with the first acute inferior wall myocardial infarction (IWMI) complicated by right ventricular myocardial infarction (RVMI) undergoing primary percutaneous coronary intervention (p-PCI).
A total of 152 patients with acute IWMI complicated by RVMI undergoing p‑PCI were divided into two groups according to the presence of RRVFP. RRVFP was defined as tricuspid diastolic early/late flow velocities (Et/At) > 2 and Et deceleration time (DT) < 120 ms.
There were 23 patients with RRVFP in the study cohort. At, DTt, isovolumetric relaxation time (IVRT), and tissue Doppler tricuspid annular late velocity (A't) were reduced significantly in patients with RRVFP than in those without RRVFP (At 19.6 ± 2.7 vs. 39.1 ± 7.4 cm/s, p < 0.001; DTt 106 ± 13 vs.156 ± 21 ms, p = 0.001; IVRT 59 ± 6.7 vs. 62 ± 7.4 ms, p = 0.01; A't 4.6 ± 1.1 vs. 8.6 ± 1.05, p = 0.001). Et/At ratios were higher in patients with RRVFP than in those without RRVFP (Et/At 2.20 ± 0.2 vs. 1.15 ± 0.37, p < 0.001). Et, tissue Doppler tricuspid annular early velocity (E't), E't/A't ratio, and Et/E't ratio were not significantly different between groups (Et 43.3 ± 5.4 vs. 40.7 ± 9.2 cm/s p = 0.18; E't 8.8 ± 1.4 vs. 9.5 ± 2.3, p = 0.15; E't/A't 1.08 ± 0.24 vs. 1.13 ± 0.30, p = 0.52; Et/E't ratio 5.0 ± 1.1 vs. 4.5 ± 1.5 p = 0.09). Presence of E't/A't > 2, short DTt, RRVFP, unsuccessful p‑PCI, and cardiogenic shock on admission were independent predictors of in-hospital mortality (p < 0.05) in multivariable logistic regression analysis.
Presence of RRVFP is associated with in-hospital mortality in patients presenting with their first IWMI complicated by RVMI.
本研究旨在探讨限制性右心室充盈模式（RRVFP）对首次发生急性下壁心肌梗死（IWMI）合并右心室心肌梗死（RVMI）并接受直接经皮冠状动脉介入治疗（p-PCI）患者的预后价值。
152例接受p-PCI的急性IWMI合并RVMI患者，根据是否存在RRVFP分为两组。RRVFP定义为三尖瓣舒张早期/晚期血流速度（Et/At）>2且Et减速时间（DT）<120 ms。
研究队列中有23例患者存在RRVFP。与无RRVFP的患者相比，存在RRVFP的患者的At、DTt、等容舒张时间（IVRT）和组织多普勒三尖瓣环晚期速度（A't）显著降低（At 19.6±2.7 vs. 39.1±7.4 cm/s，p<0.001；DTt 106±13 vs.156±21 ms，p = 0.001；IVRT 59±6.7 vs. 62±7.4 ms，p = 0.01；A't 4.6±1.1 vs. 8.6±1.05，p = 0.001）。存在RRVFP的患者的Et/At比值高于无RRVFP的患者（Et/At 2.20±0.2 vs. 1.15±0.37，p<0.001）。两组之间的Et、组织多普勒三尖瓣环早期速度（E't）、E't/A't比值和Et/E't比值无显著差异（Et 43.3±5.4 vs. 40.7±9.2 cm/s p = 0.18；E't 8.8±1.4 vs. 9.5±2.3，p = 0.15；E't/A't 1.08±0.24 vs. 1.13±0.30，p = 0.52；Et/E't比值5.0±1.1 vs. 4.5±1.5 p = 0.09）。在多变量逻辑回归分析中，E't/A't>2、短DTt、RRVFP、p-PCI失败和入院时的心源性休克是院内死亡的独立预测因素（p<0.05）。
RRVFP的存在与首次发生IWMI合并RVMI患者的院内死亡率相关。
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