超声心动图舒张功能在急性前壁心肌梗死患者中的演变：来自 REVE-2 研究的见解。
Echocardiographic diastolic function evolution in patients with an anterior Q-wave myocardial infarction: insights from the REVE-2 study.
机构信息
Centre d'Investigation Clinique CIC-P 1433, INSERM, Nancy, France.
F-CRIN INI-CRCT, Nancy, France.
出版信息
ESC Heart Fail. 2019 Feb;6(1):70-79. doi: 10.1002/ehf2.12359. Epub 2018 Nov 20.
AIMS
Myocardial fibrosis plays a key role in the development of adverse left ventricular remodelling after myocardial infarction (MI). This study aimed to determine whether the circulating levels of BNP, collagen peptides, and galectin-3 are associated with diastolic function evolution (both deterioration and improvement) at 1 year after an anterior MI.
METHODS AND RESULTS
The REVE-2 is a prospective multicentre study including 246 patients with a first anterior Q-wave MI. Echocardiographic assessment was performed at hospital discharge and ±1 year after MI. BNP, galectin-3, and collagen peptides were measured ±1 month after MI. Left ventricular diastolic dysfunction (DD) was defined according to the presence of at least two criteria of echocardiographic parameters: septal e' < 8 cm/s, lateral e' < 10 cm/s, and left atrial volume ≥ 34 mL/m . At baseline, 87 (35.4%) patients had normal diastolic function and 159 (64.6%) patients had DD. Follow-up of 61 patients among the 87 patients with normal diastolic function at baseline showed that 22 patients (36%) developed DD at 1 year post-MI. The circulating levels of amino-terminal propeptide of type III procollagen > 6 mg/L [odds ratio (OR) = 5.29; 95% confidence interval (CI) = 1.05-26.66; P = 0.044], galectin-3 > 13 μg/L (OR = 5.99; 95% CI = 1.18-30.45; P = 0.031), and BNP > 82 ng/L (OR = 10.25; 95% CI = 2.36-44.50; P = 0.002) quantified at 1 month post-MI were independently associated with 1 year DD. Follow-up of the 137 patients with DD at baseline among the 159 patients showed that 36 patients (26%) had a normalized diastolic function at 1 year post-MI. Patients with a BNP > 82 ng/L were less likely to improve diastolic function (OR = 0.06; 95% CI = 0.01-0.28; P = 0.0003).
CONCLUSIONS
The present study suggests that circulating levels of amino-terminal propeptide of type III procollagen, galectin-3, and BNP may be independently associated with new-onset DD in post-MI patients.
目的
心肌纤维化在心肌梗死后（MI）左心室不良重构的发展中起着关键作用。本研究旨在确定在 MI 后 1 年，BNP、胶原肽和半乳糖凝集素-3 的循环水平是否与舒张功能的演变（恶化和改善）相关。
方法和结果
REVE-2 是一项前瞻性多中心研究，包括 246 例首次前壁 Q 波 MI 患者。在出院时和 MI 后±1 年进行超声心动图评估。在 MI 后±1 个月测量 BNP、半乳糖凝集素-3 和胶原肽。根据超声心动图参数的至少两项标准定义左心室舒张功能障碍（DD）：间隔 e' < 8 cm/s、侧壁 e' < 10 cm/s 和左心房容积≥34 mL/m。在基线时，87 例（35.4%）患者舒张功能正常，159 例（64.6%）患者存在 DD。对基线时舒张功能正常的 87 例患者中的 61 例进行随访，结果显示 22 例（36%）在 MI 后 1 年出现 DD。在 MI 后 1 个月时，III 型前胶原氨基末端肽 > 6mg/L[比值比（OR）=5.29；95%置信区间（CI）=1.05-26.66；P=0.044]、半乳糖凝集素-3>13μg/L（OR=5.99；95%CI=1.18-30.45；P=0.031）和 BNP>82ng/L（OR=10.25；95%CI=2.36-44.50；P=0.002）与 1 年 DD 独立相关。对 159 例 DD 患者中的 137 例进行基线随访，结果显示 36 例（26%）在 MI 后 1 年舒张功能正常。BNP>82ng/L 的患者舒张功能改善的可能性较低（OR=0.06；95%CI=0.01-0.28；P=0.0003）。
结论
本研究表明，III 型前胶原氨基末端肽、半乳糖凝集素-3 和 BNP 的循环水平可能与 MI 后新发 DD 独立相关。
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