三甲胺 N-氧化物与首次前壁 ST 段抬高型心肌梗死患者直接血管重建术后 30 天左心室收缩功能障碍无关：光学相干断层扫描注册研究的亚组分析
Trimethylamine N-Oxide Was Not Associated With 30-Day Left Ventricular Systolic Dysfunction in Patients With a First Anterior ST-Segment Elevation Myocardial Infarction After Primary Revascularization: A Sub-analysis From an Optical Coherence Tomography Registry.
作者信息
Zhou Jinying, Yu Shiqin, Tan Yu, Zhou Peng, Liu Chen, Sheng Zhaoxue, Li Jiannan, Chen Runzhen, Zhao Shihua, Yan Hongbing
机构信息
Department of Coronary Heart Disease, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Magnetic Resonance Centre, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
出版信息
Front Cardiovasc Med. 2020 Dec 23;7:613684. doi: 10.3389/fcvm.2020.613684. eCollection 2020.
Left ventricular systolic dysfunction (LVSD) after ST-segment elevation myocardial infarction (STEMI) is associated with poor outcome. Trimethylamine N-oxide (TMAO), a gut metabolite, is linked to cardiovascular diseases but its relationship with LVSD after STEMI remains unclear. The present study therefore aimed to investigate the relationship between TMAO and LVSD at 30 days after a first anterior STEMI. This was a sub-study from the OCTAMI (Optical Coherence Tomography Examination in Acute Myocardial Infarction) registry. Eligible patients were included in current study if they: (1) presented with a first anterior STEMI; (2) had available baseline TMAO concentration; (3) completed a cardiovascular magnetic resonance examination at 30 days after STEMI. LVSD was defined as left ventricular ejection fraction < 50%. Associations between TMAO and left ventricular ejection fraction, infarct size and left ventricular global strain were examined. In total, 78 patients were included in final analysis. Overall, TMAO was moderately associated with peak cTnI ( = 0.27, = 0.01), age ( = 0.34, < 0.01), and estimated glomerular filtration rate ( = -0.30, < 0.01). At 30-day follow-up, 41 patients were in the LVSD group and 37 in the non-LVSD group. Baseline TMAO levels were not significantly different between the two groups (LVSD vs. non-LVSD: median 1.9 μM, 25-75th percentiles 1.5-3.3 μM vs. median 1.9 μM, 25-75th percentiles 1.5-2.7 μM; = 0.46). Linear regression analyses showed that TMAO was not associated with left ventricular ejection fraction, infarct size or left ventricular global strain at 30 days (all > 0.05). TMAO was not significantly correlated with 30-day LVSD in patients with a first anterior STEMI after primary revascularization. www.ClinicalTrials.gov, identifier: NCT03593928.
ST段抬高型心肌梗死（STEMI）后的左心室收缩功能障碍（LVSD）与不良预后相关。三甲胺N-氧化物（TMAO）是一种肠道代谢产物，与心血管疾病有关，但其与STEMI后LVSD的关系尚不清楚。因此，本研究旨在探讨首次前壁STEMI后30天时TMAO与LVSD之间的关系。这是一项来自OCTAMI（急性心肌梗死光学相干断层扫描检查）注册研究的子研究。符合条件的患者若具备以下情况则纳入本研究：（1）首次发生前壁STEMI；（2）有可用的基线TMAO浓度；（3）在STEMI后30天完成心血管磁共振检查。LVSD定义为左心室射血分数<50%。研究了TMAO与左心室射血分数、梗死面积和左心室整体应变之间的关联。最终共有78例患者纳入分析。总体而言，TMAO与肌钙蛋白I峰值（r = 0.27，P = 0.01）、年龄（r = 0.34，P < 0.01）和估计肾小球滤过率（r = -0.30，P < 0.01）中度相关。在30天随访时，41例患者在LVSD组，37例在非LVSD组。两组间基线TMAO水平无显著差异（LVSD组与非LVSD组：中位数1.9 μM，第25至75百分位数1.5 - 3.3 μM vs.中位数1.9 μM，第25至75百分位数1.5 - 2.7 μM；P = 0.46）。线性回归分析显示，30天时TMAO与左心室射血分数、梗死面积或左心室整体应变均无关联（均P > 0.05）。在首次前壁STEMI患者接受初次血运重建后，TMAO与30天LVSD无显著相关性。ClinicalTrials.gov网站，标识符：NCT03593928。
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