1 British Heart Foundation Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow United Kingdom.
3 West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Glasgow United Kingdom.
J Am Heart Assoc. 2018 Aug 7;7(15):e008957. doi: 10.1161/JAHA.118.008957.
Background Invasive measures of microvascular resistance in the culprit coronary artery have potential for risk stratification in acute ST-segment-elevation myocardial infarction. We aimed to investigate the pathological and prognostic significance of coronary thermodilution waveforms using a diagnostic guidewire. Methods and Results Coronary thermodilution was measured at the end of percutaneous coronary intervention, (PCI) and contrast-enhanced cardiac magnetic resonance imaging (MRI) was intended on day 2 and 6 months later to assess left ventricular (LV) function and pathology. All-cause death or first heart failure hospitalization was a pre-specified outcome (median follow-up duration 1469 days). Thermodilution recordings underwent core laboratory assessment. A total of 278 patients with acute ST-segment elevation myocardial infarction EMI (72% male, 59±11 years) had coronary thermodilution measurements classified as narrow unimodal (n=143 [51%]), wide unimodal (n=100 [36%]), or bimodal (n=35 [13%]). Microvascular obstruction and myocardial hemorrhage were associated with the thermodilution waveform pattern ( P=0.007 and 0.011, respectively), and both pathologies were more prevalent in patients with a bimodal morphology. On multivariate analysis with baseline characteristics, thermodilution waveform status was a multivariable associate of microvascular obstruction (odds ratio [95% confidence interval]=5.29 [1.73, 16.22];, P=0.004) and myocardial hemorrhage (3.45 [1.16, 10.26]; P=0.026), but the relationship was not significant when index of microvascular resistance (IMR) >40 or change in index of microvascular resistance (5 per unit) was included. However, a bimodal thermodilution waveform was independently associated with all-cause death and hospitalization for heart failure (odds ratio [95% confidence interval]=2.70 [1.10, 6.63]; P=0.031), independent of index of microvascular resistance>40, ST-segment resolution, and TIMI (Thrombolysis in Myocardial Infarction) Myocardial Perfusion Grade. Conclusions The thermodilution waveform in the culprit coronary artery is a biomarker of prognosis and may be useful for risk stratification immediately after reperfusion therapy.
在急性 ST 段抬高型心肌梗死中，对罪犯冠状动脉的微血管阻力进行有创性评估具有风险分层的潜力。我们旨在使用诊断导丝研究冠状动脉热稀释波形的病理和预后意义。
在经皮冠状动脉介入治疗（PCI）结束时测量冠状动脉热稀释，计划在第 2 天和 6 个月后进行对比增强心脏磁共振成像（MRI）以评估左心室（LV）功能和病理学。全因死亡或首次心力衰竭住院是预先指定的结局（中位随访时间 1469 天）。热稀释记录接受了核心实验室评估。共有 278 例急性 ST 段抬高型心肌梗死（STEMI）患者（72%为男性，59±11 岁）进行了冠状动脉热稀释测量，分为狭窄单峰（n=143[51%]）、宽单峰（n=100[36%]）或双峰（n=35[13%]）。微血管阻塞和心肌出血与热稀释波型模式相关（P=0.007 和 0.011），双峰形态患者的两种病理学更为普遍。在基线特征的多变量分析中，热稀释波型状态是微血管阻塞的多变量相关因素（优势比[95%置信区间]=5.29[1.73, 16.22]；P=0.004）和心肌出血（3.45[1.16, 10.26]；P=0.026），但当微血管阻力指数（IMR）>40 或微血管阻力变化（每单位 5）时，相关性不显著。然而，双峰热稀释波型与全因死亡和心力衰竭住院独立相关（优势比[95%置信区间]=2.70[1.10, 6.63]；P=0.031），与 IMR>40、ST 段分辨率和 TIMI（心肌梗死溶栓）心肌灌注分级无关。
罪犯冠状动脉中的热稀释波型是一种预后生物标志物，可能对再灌注治疗后立即进行风险分层有用。
