John Hunter Hospital, Newcastle, Australia.
The University of Newcastle, Australia.
Eur Heart J Acute Cardiovasc Care. 2020 Oct;9(7):758-763. doi: 10.1177/2048872618819657. Epub 2018 Dec 20.
Elevated left ventricular end diastolic pressure (LVEDP) is an independent predictor of mortality and heart failure in patients with ST-segment elevation myocardial infarction (STEMI). Whether lowering elevated LVEDP improves outcomes remains unknown.
This non-randomized, single blinded study with prospective enrolment and sequential group allocation recruited patients undergoing primary percutaneous coronary intervention for STEMI with LVEDP ⩾ 20 mmHg measured immediately after primary percutaneous coronary intervention. The intervention arm (=10) received furosemide 40 mg intravenous bolus plus escalating doses of glyceryl trinitrate (100 µg per min to a maximum of 1000 µg) during simultaneous measurement of LVEDP. The control group (=10) received corresponding normal saline boluses with simultaneous measurement of LVEDP (10 readings over 10 min). Efficacy endpoints were final LVEDP achieved, and the dose of glyceryl trinitrate needed to reduce LVEDP by ⩾ 20%. Safety endpoint was symptomatic hypotension (systolic blood pressure < 90 mmHg).
From 1 April 2017 to 23 August 2017 we enrolled 20 patients (age: 64±9 years, males: 60%, =12, anterior STEMI: 65%, =13). The mean LVEDP for the whole cohort (=20) was 29±4 mmHg (intervention group: 28±3 mmHg . control group: 31±5 mmHg; =0.1). The LVEDP dropped from 28±3 to 16±2 mmHg in the glyceryl trinitrate + furosemide group ( <0.01) but remained unchanged in the control group. The median dose of glyceryl trinitrate required to produce ⩾ 20% reduction in LVEDP in the intervention group was 200 µg (range: 100-800). One patient experienced asymptomatic decline in systolic blood pressure to below 90 mmHg. There was no correlation between LVEDP and left ventricular ejection fraction.
The administration of glyceryl trinitrate plus furosemide in patients with elevated LVEDP following primary percutaneous coronary intervention for STEMI safely reduces LVEDP.
左心室舒张末期压（LVEDP）升高是 ST 段抬高型心肌梗死（STEMI）患者死亡和心力衰竭的独立预测因子。降低升高的 LVEDP 是否能改善预后尚不清楚。
这是一项非随机、单盲、前瞻性入组和序贯分组的研究，纳入了因 STEMI 行直接经皮冠状动脉介入治疗（pPCI）且 LVEDP ⩾20mmHg 的患者。LVEDP 在 pPCI 后即刻测量。干预组（=10）在同时测量 LVEDP 的情况下接受呋塞米 40mg 静脉推注加硝酸甘油递增剂量（100μg/min，最大 1000μg）。对照组（=10）在同时测量 LVEDP（10 次读数，共 10min）的情况下接受相应的生理盐水推注。有效性终点为最终 LVEDP 水平，以及降低 LVEDP ⩾20%所需的硝酸甘油剂量。安全性终点为症状性低血压（收缩压 ⩽90mmHg）。
从 2017 年 4 月 1 日至 2017 年 8 月 23 日，我们共纳入 20 例患者（年龄：64±9 岁，男性：60%，=12，前壁 STEMI：65%，=13）。整个队列的平均 LVEDP（=20）为 29±4mmHg（干预组：28±3mmHg，对照组：31±5mmHg，=0.1）。硝酸甘油+呋塞米组的 LVEDP 从 28±3mmHg 降至 16±2mmHg（ <0.01），而对照组无变化。干预组降低 LVEDP ⩾20%所需的硝酸甘油中位剂量为 200μg（范围：100-800）。1 例患者出现无症状收缩压下降至 90mmHg 以下。LVEDP 与左心室射血分数之间无相关性。
在 STEMI 行直接 pPCI 后，LVEDP 升高的患者应用硝酸甘油加呋塞米治疗可安全降低 LVEDP。
