自然轻度低温对ST段抬高型心肌梗死早期的影响：心脏磁共振成像研究
Impact of Natural Mild Hypothermia in the Early Phase of ST-Elevation Myocardial Infarction: Cardiac Magnetic Resonance Imaging Study.
作者信息
Lim Kyunghee, Yang Jeong Hoon, Hahn Joo-Yong, Choi Seung-Hyuk, Gwon Hyeon-Cheol, Park Sung-Ji, Song Young Bin
机构信息
Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
出版信息
J Cardiovasc Imaging. 2018 Sep;26(3):175-185. doi: 10.4250/jcvi.2018.26.e21. Epub 2018 Sep 20.
BACKGROUND
Mild hypothermia (32-35°C) during acute myocardial ischemia has been considered cardioprotective in animal studies. We sought to determine the association of between natural mild hypothermia and myocardial salvage as assessed by cardiac magnetic resonance imaging (CMR) in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).
METHODS
In 291 patients with STEMI, CMR was performed a median of 3 days after the index event. Body temperature was collected for 24 hours after PCI. Fifty-one patients (17.5%) had natural mild hypothermia (less than 35°C) during the day after PCI, and 240 (82.5%) did not.
RESULTS
The primary endpoint, the myocardial salvage index, was significantly higher in the natural mild hypothermia group than in the normothermia group (median [IQR], 50 [37-64] vs. 43 [30-56], p = 0.013). The myocardial area at risk between the 2 groups did not differ (39 [22-51] vs. 35 [24-44], p = 0.361), nor did the infarct size (16 [10-28] vs. 20 [12-27], p = 0.301), presence of microvascular obstruction (57% vs. 60%, p=0.641), or hemorrhagic infarction (43% vs. 46%, p = 0.760). A multivariable linear regression showed a significant association between the lowest body temperature and myocardial salvage index (β = -0.191, p = 0.001).
CONCLUSIONS
In patients with STEMI undergoing primary PCI, natural mild hypothermia within 24 hours is associated with greater salvaged myocardium.
背景
在动物研究中，急性心肌缺血期间的轻度低温（32 - 35°C）被认为具有心脏保护作用。我们试图确定在接受直接经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者中，通过心脏磁共振成像（CMR）评估的自然轻度低温与心肌挽救之间的关联。
方法
对291例STEMI患者在索引事件发生后中位数3天进行CMR检查。PCI术后收集24小时体温。51例患者（17.5%）在PCI术后当天出现自然轻度低温（低于35°C），240例（82.5%）未出现。
结果
主要终点指标心肌挽救指数，自然轻度低温组显著高于正常体温组（中位数[四分位间距]，50[37 - 64]对43[30 - 56]，p = 0.013）。两组之间的心肌危险区域无差异（39[22 - 51]对35[24 - 44]，p = 0.361），梗死面积也无差异（16[10 - 28]对20[12 - 27]，p = 0.301），微血管阻塞的存在情况（57%对60%，p = 0.641）或出血性梗死情况（43%对46%，p = 0.760）也无差异。多变量线性回归显示最低体温与心肌挽救指数之间存在显著关联（β = -0.191，p = 0.001）。
结论
在接受直接PCI的STEMI患者中，24小时内的自然轻度低温与更多的挽救心肌相关。
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