Figueras Jaume, Bañeras Jordi, Gruosso Domenico, Rodriguez Palomares Jose, Barrabés José A, Garcia-Dorado David
Coronary Care Unit, Cardiology Service, University Hospital Vall d'Hebron, Barcelona, Spain.
Coron Artery Dis. 2019 Jan;30(1):11-19. doi: 10.1097/MCA.0000000000000665.
The relationship between admission left ventricular (LV) volumes, regional contractility and persistent ST elevation in first anterior ST elevation myocardial infarction (STEMI) with evolution of LV volumes at 12 months remains inconclusive. Thus possible differences among patients with reverse dilatation (RD), stationary dilatation (SD) or progressive dilatation (PD) at 12 months based on left ventricle end-systolic volume (LVESV) index changes were investigated.
ECG and echocardiographic features of 394 1-year survivors of anterior STEMI were analyzed at admission, 6 and 12 months in those with RD (≥15% reduction of LVESV index, at 12 months n=141), SD (<15% reduction or increase, n=123) or PD (≥15% increase, n=130). Long-term outcome was also evaluated.
Admission LVESV values in tertiles and incidence of moderate-severe mitral regurgitation were similar in three groups. In patients with RD, LVESV decreased at 6 months (P<0.001) and further at 12 months (P=0.003), whereas in PD, it increased at 6 months (P<0.001) and further at 12 months (P=0.016). Contractility score in PD was higher on admission (P=0.050) than in the other groups, but it involved the same segments. At 12 months, it improved in each of the six most affected in RD (P<0.001) and SD (P=0.025-0.001) but not in PD group (P=0.452-1.00). Persistent ST elevation at 24 h and peak troponin I were the only independent predictors for RD (odds ratio: 0.900, 95% confidence interval: 0.840-0.905, P=0.003; 0.996, 0.986-0.994, P<0.001) and PD (1.143, 1.001-1.304, P=0.048; 1.004, 1.002-1.006, P<0.001), respectively. During an 8-year follow-up, 77 (19.5%) patients died and although the total mortality was comparable in the three groups, cardiac death or hospitalization for heart failure was higher in the PD (16/130, 14%) than in the other two groups (14/250, 5.6%, P=0.014).
Admission normal or enlarged LV volumes may evolve towards RD, SD or PD at 12 months following first anterior STEMI mainly depending in part on infarct size. Importantly, relevant changes occur at not only 6 months but also between 6 and 12 months.
首次前壁ST段抬高型心肌梗死（STEMI）患者入院时左心室（LV）容积、局部收缩功能与持续性ST段抬高之间的关系，以及12个月时LV容积的变化情况仍无定论。因此，本研究基于左心室收缩末期容积（LVESV）指数变化，探讨了12个月时出现逆向扩张（RD）、静止性扩张（SD）或进行性扩张（PD）的患者之间可能存在的差异。
分析了394例前壁STEMI 1年幸存者的心电图和超声心动图特征，这些患者在入院时、6个月和12个月时分别被分为RD组（LVESV指数降低≥15%，12个月时n = 141）、SD组（降低或增加<15%，n = 123）或PD组（增加≥15%，n = 130）。同时评估了长期预后。
三组患者入院时LVESV值的三分位数及中重度二尖瓣反流的发生率相似。RD组患者的LVESV在6个月时降低（P<0.001），12个月时进一步降低（P = 0.003）；而PD组患者的LVESV在6个月时增加（P<0.001），12个月时进一步增加（P = 0.016）。PD组患者入院时的收缩功能评分高于其他组（P = 0.050），但涉及的节段相同。12个月时，RD组和SD组中受影响最严重的六个节段的收缩功能均有所改善（RD组P<0.001，SD组P = 0.025 - 0.001），而PD组未改善（P = 0.452 - 1.00）。24小时持续性ST段抬高和肌钙蛋白I峰值分别是RD组（比值比：0.900，95%置信区间：0.840 - 0.905，P = 0.003；0.996，0.986 - 0.994，P<0.001）和PD组（1.143，1.001 - 1.304，P = 0.048；1.004，1.002 - 1.006，P<0.001）的唯一独立预测因素。在8年的随访期间，77例（19.5%）患者死亡，尽管三组的总死亡率相当，但PD组因心脏死亡或心力衰竭住院的比例高于其他两组（16/130，14%对比14/250，5.6%，P = 0.014）。
首次前壁STEMI后12个月，入院时正常或增大的LV容积可能演变为RD、SD或PD，这主要部分取决于梗死面积。重要的是，相关变化不仅发生在6个月时，也发生在6至12个月之间。
