National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow, Russia.
National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow, Russia I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
Kardiologiia. 2021 Feb 10;61(1):44-51. doi: 10.18087/cardio.2021.1.n1373.
Aim To evaluate factors associated with unfavorable predictive characteristics of ST-segment elevation acute myocardial infarction (STEMI) as per data of magnetic resonance imaging (MRI).Material and methods The study included 52 patients with STEMI who underwent a primary percutaneous coronary intervention (pPCI). Contrast-enhanced cardiac MRI was performed for all patients on days 3-7. Delayed contrast-enhancement images were used for assessing infarct size, presence of microvascular obstruction (MVO) areas, and heterogeneity zones.Results Multifactorial analysis showed that independent predictors of MVO were type 2 diabetes mellitus (DM) (relative risk (RR) 1.9, confidence interval (CI): 1.1-3.26, р=0.012), increased levels of brain natriuretic peptide (BNP) (RR 2.04, CI: 1.39-2.99, р=0.004) and creatine kinase (CK) (RR 2.06, CI: 0.52-0.80, р=0.02), and infarct size (IS) (RR 2.81; CI: 1.38-5.72, р=0.0004). Construction of ROC curves provided the quantitative values of study indexes, at which the risk of MVO increased. For BNP, this value was ≥276 pg/ml (sensitivity, 95.7 %; specificity, 37.9 %); for CK ≥160 U/l (sensitivity, 74.1 %; specificity, 61.9 %); and for IS ≥18.8 % (sensitivity, 79.3 %; specificity, 69.6 %). Correlation analysis of risk factors for increased size of the heterogeneity zone showed significant correlations of the heterogeneity zone size with older age of patients (r=0.544, р<0.0001), higher concentrations of BNP (r=0.612, р<0.0001), CK (r=0.3, 95 % CI: 0.02-0.5, р=0.03), and C-reactive protein (CRP) (r=0.59, CI: 0.3-0.7, р=0.0001). Increased levels of CK (r=0.53, 95 % CI: 0.29-0.70, р=0.0001) and BNP (r=0.55, 95 % CI: 0.28-0.70, p=0.0003) significantly correlated with increased IS.Conclusion Risk of MVO formation as per MRI data increased in the presence of type 2 DM and IS ≥18.8 % (р<0.05). Formation of MVO in patients with STEMI was associated with increased levels of BNP ≥276 pg/ml and CK ≥160 U/l (р<0.05). Increased levels of BNP, CK, and CRP were associated with a larger size of heterogeneity zone according to data of the correlation analysis. A larger heterogeneity zone was more typical for older patients. Increased levels of CK and BNP were also associated with larger IS. The correlation analysis did not show any significant interactions between the size of heterogeneity zone, IS, and MVO size (р>0.05).
目的 根据磁共振成像（MRI）数据评估与 ST 段抬高型急性心肌梗死（STEMI）不利预测特征相关的因素。
材料与方法 本研究纳入了 52 例接受直接经皮冠状动脉介入治疗（pPCI）的 STEMI 患者。所有患者均在第 3-7 天行对比增强心脏 MRI。使用延迟对比增强图像评估梗死面积、存在的微血管阻塞（MVO）区和异质性区。
结果 多因素分析显示，MVO 的独立预测因子为 2 型糖尿病（DM）（相对风险（RR）1.9，置信区间（CI）：1.1-3.26，p=0.012）、脑钠肽（BNP）（RR 2.04，CI：1.39-2.99，p=0.004）和肌酸激酶（CK）（RR 2.06，CI：0.52-0.80，p=0.02）水平升高以及梗死面积（IS）（RR 2.81；CI：1.38-5.72，p=0.0004）。ROC 曲线的构建提供了研究指标的定量值，其中 MVO 的风险增加。对于 BNP，该值为≥276pg/ml（灵敏度，95.7%；特异性，37.9%）；对于 CK≥160U/l（灵敏度，74.1%；特异性，61.9%）；对于 IS≥18.8%（灵敏度，79.3%；特异性，69.6%）。异质性区大小增加的危险因素相关性分析显示，异质性区大小与患者年龄较大（r=0.544，p＜0.0001）、BNP（r=0.612，p＜0.0001）、CK（r=0.3，95%CI：0.02-0.5，p=0.03）和 C 反应蛋白（CRP）（r=0.59，CI：0.3-0.7，p=0.0001）浓度升高显著相关。CK（r=0.53，95%CI：0.29-0.70，p=0.0001）和 BNP（r=0.55，95%CI：0.28-0.70，p=0.0003）水平升高与 IS 增加显著相关。
结论 根据 MRI 数据，2 型糖尿病和 IS≥18.8%（p＜0.05）的存在使 MVO 形成的风险增加。STEMI 患者的 MVO 形成与 BNP≥276pg/ml 和 CK≥160U/l 水平升高有关（p＜0.05）。根据相关性分析的数据，BNP、CK 和 CRP 水平升高与异质性区大小增加相关。更大的异质性区更常见于年龄较大的患者。CK 和 BNP 水平升高也与更大的 IS 相关。相关性分析未显示异质性区大小、IS 和 MVO 大小之间存在任何显著的相互作用（p＞0.05）。
