心肌梗死后心力衰竭进展的早期预测因子。

Early Predictors of Heart Failure Progression in Patients After Myocardial Infarction.

机构信息

Penza State University, Penza.

出版信息

Kardiologiia. 2020 Dec 15;60(11):1309. doi: 10.18087/cardio.2020.11.n1309.

DOI:10.18087/cardio.2020.11.n1309

Abstract

Aim To identify early predictors for progression of chronic heart failure (CHF) in patients with ST-segment elevation myocardial infarction (STEMI).Material and methods The study included 113 patients with STEMI aged 52 (95 % confidence interval, 36 to 65) years. 24-h ECG monitoring was performed with assessment of ventricular late potentials, QT dispersion, heart rhythm turbulence (HRT), and heart rhythm variability (HRV); XStrain 2D echocardiograpy with determination of volumetric parameters, myocardial strain characteristics and velocities; and measurement of brain natriuretic peptide (BNP) concentrations. The endpoint was CHF progression during 48 weeks of follow-up, which was observed in 26 (23 %) patients. Based on the outcome, two groups were isolated, with CHF progression (Prg) (26(23%)) and with a relatively stable CHF postinfarction course (Stb) (87 (77 %)).Results At 12 weeks following MI, the Prg group showed increases in left ventricular (LV) end-diastolic dimension (EDD) (р<0.05) and end-diastolic and end-systolic volumes (EDV, ESV), (р<0.01), and EDV and ESV indexes (EDVi and ESVi, р<0.01). In this group, global longitudinal strain (GLS) was decreased at 24 weeks (р<0.05) and global radial strain (GRS) was decreased at 48 weeks (р=0.0003). In the Prg group, values of strain parameters (GLS, global circular strain (GCS), and GRS) were lower at all times. At 7-9 days, 24 weeks, and 48 weeks, the proportion of patients with pathological HRT was higher in the Prg group (38, 27, and 19 % for the Prg group vs 14 % (р=0.006); 3,4 % (р=0.001), and 2.3 % (р=0.002) for the Stb group, respectively). Only in the Stb group, increases in HRV were observed (SDNNi by 13 % (р=0.001), rMSSD by 24 % (р=0.0002), TotP by 49 % (р=0.00002), VLfP by 23 % (р=0.003), LfP by 22 % (р=0.008), and HfP by 77 % (р=0.002). At 7-9 days of MI, the Stb group had greater values of SDANN (р=0.013) and HfP (р=0.01). CHF progression correlated with abnormal values of turbulence onset (TO), disturbed HRT, increased BNP levels and LV ESD, and low values of GLS, GCS, and GRS. Combined assessment of HRT, LV ESD, and GLS at 7-9 days after STEMI allows identifying patients with high risk for CHF progression in the next 48 weeks.Conclusion The markers for CHF progression after STEMI include abnormal TO values, disturbed HRT, increased BNP levels and LV ESD, and low values of GLS, GCS, and GRS. The multifactor logistic regression analysis revealed early predictors of CHF in the postinfarction period, including abnormal TO, increased LV ESD, and reduced GLS.

摘要

目的

确定 ST 段抬高型心肌梗死（STEMI）患者慢性心力衰竭（CHF）进展的早期预测因子。

材料与方法

本研究纳入了 113 名年龄为 52 岁（95%置信区间：36 岁至 65 岁）的 STEMI 患者。进行了 24 小时心电图监测，评估心室晚期电位、QT 离散度、心率震荡（HRT）和心率变异性（HRV）；进行了 XStrain 二维超声心动图检查，确定容积参数、心肌应变特征和速度；并测量了脑钠肽（BNP）浓度。终点是在 48 周随访期间发生 CHF 进展，共有 26 名（23%）患者发生了 CHF 进展。根据结局，将患者分为 CHF 进展组（Prg）（26 例（23%））和相对稳定的心肌梗死后 CHF 组（Stb）（87 例（77%））。

结果

在 MI 后 12 周，Prg 组左心室（LV）舒张末期内径（EDD）增加（р<0.05），舒张末期和收缩末期容积（EDV、ESV）增加（р<0.01），EDV 和 ESV 指数（EDVi 和 ESVi）增加（р<0.01）。在该组中，24 周时整体纵向应变（GLS）下降（р<0.05），48 周时整体径向应变（GRS）下降（р=0.0003）。在 Prg 组，所有时间点的应变参数（GLS、整体圆周应变（GCS）和 GRS）值均较低。在 7-9 天、24 周和 48 周时，Prg 组病理性 HRT 的患者比例更高（38%、27%和 19% vs 14%，р=0.006；3%、4%和 2.3%，р=0.001 和 р=0.002，分别）。只有在 Stb 组观察到 HRV 增加（SDNNi 增加 13%，р=0.001；rMSSD 增加 24%，р=0.0002；TotP 增加 49%，р=0.00002；VLfP 增加 23%，р=0.003；LfP 增加 22%，р=0.008；和 HfP 增加 77%，р=0.002）。在 MI 后 7-9 天，Stb 组的 SDANN（р=0.013）和 HfP（р=0.01）值更高。CHF 进展与湍流起始（TO）异常值、HRT 紊乱、BNP 水平升高和 LV ESD 以及 GLS、GCS 和 GRS 值降低相关。STEMI 后 7-9 天 HRT、LV ESD 和 GLS 的联合评估可识别出未来 48 周内 CHF 进展风险较高的患者。