Bordejevic Diana Aurora, Pârvănescu Tudor, Petrescu Lucian, Mornoș Cristian, Olariu Ioan, Crișan Simina, Văcărescu Cristina, Lazăr Mihai, Morariu Vlad Ioan, Citu Ioana Mihaela, Tomescu Mirela Cleopatra, Cozma Dragoș
Cardiology Department, Institute of Cardiovascular Diseases, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
Cardiology Department, City Hospital, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
Ther Clin Risk Manag. 2021 Mar 23;17:249-258. doi: 10.2147/TCRM.S295251. eCollection 2021.
Patients with acute myocardial infarction (AMI) are at high risk for left ventricular (LV) remodeling and heart failure. We aimed to study whether LV strains (S) and strain rates (SR) could predict cardiac remodeling in patients with AMI having a midrange or preserved LV ejection fraction (EF) following a percutaneous coronary intervention (PCI) within the first 12 hours from the onset of symptoms.
This is a case-control observational study including patients admitted for their first AMI, either with ST-segment elevation (STEMI) or without ST elevation (NSTEMI), with an LVEF > 40% after a successful PCI. Echocardiography was repeated after 6 months, and the patients were divided into two groups, according to whether LV remodeling was determined on echocardiography.
Of the 253 AMI patients (mean 66 aged ± 13 years), including 185 males (73%), 61 (24%) presented signs of LV remodeling. In univariate logistic regression analysis, age, male sex, smoking history, hypertension, hypercholesterolemia, Killip class, renal function, peak creatine phosphokinase - MB level, 2- and 3-vessel coronary artery disease (CAD), and several echocardiographic parameters were significantly associated with LV remodeling (<0.05). In multivariate logistic regression analysis harmed (H) LS and SR, Killip class, 3-vessel CAD, and LV end-diastolic volume were outlined as independent predictors for LV remodeling. Receiver operating characteristic curve analyses showed that HLS and HLSR were the most powerful independent predictors for LV remodeling (<0.001), with an area under the curve (AUC) of 0.85 (sensitivity 83%; specificity 84%; p <0.001) and 0.77 (sensitivity 93; specificity 61%; p <0.001), respectively. The identified cut-off values for predictor variables were HLS< -11%, and HLSR< -0.65s.
We concluded that 2D-STE was the best method to evaluate LV remodeling in patients with AMI and midrange or preserved LVEF following myocardial revascularization by a PCI.
急性心肌梗死（AMI）患者发生左心室（LV）重构和心力衰竭的风险很高。我们旨在研究LV应变（S）和应变率（SR）是否能够预测症状发作后12小时内接受经皮冠状动脉介入治疗（PCI）的AMI患者，其LV射血分数（EF）处于中等范围或保留时的心脏重构情况。
这是一项病例对照观察性研究，纳入首次因AMI入院的患者，包括ST段抬高型心肌梗死（STEMI）或非ST段抬高型心肌梗死（NSTEMI），成功PCI后LVEF>40%。6个月后重复进行超声心动图检查，并根据超声心动图是否确定存在LV重构将患者分为两组。
在253例AMI患者（平均年龄66±13岁）中，包括185例男性（73%），61例（24%）出现LV重构迹象。在单因素逻辑回归分析中，年龄、男性性别、吸烟史、高血压、高胆固醇血症、Killip分级、肾功能、肌酸磷酸激酶-MB峰值水平、双支和三支冠状动脉疾病（CAD）以及几个超声心动图参数与LV重构显著相关（<0.05）。在多因素逻辑回归分析中，受损（H）LS和SR、Killip分级、三支CAD和LV舒张末期容积被确定为LV重构的独立预测因素。受试者工作特征曲线分析表明，HLS和HLSR是LV重构最有力的独立预测因素（<0.001），曲线下面积（AUC）分别为0.85（敏感性83%；特异性84%；p<0.001）和0.77（敏感性93；特异性61%；p<0.001）。预测变量的确定截断值为HLS<-11%，HLSR<-0.65s。
我们得出结论，二维应变超声心动图（2D-STE）是评估PCI心肌血运重建后AMI患者且LV EF处于中等范围或保留时LV重构的最佳方法。
