ST段抬高型心肌梗死患者重复远隔缺血预处理的心脏保护作用
Cardioprotection of Repeated Remote Ischemic Conditioning in Patients With ST-Segment Elevation Myocardial Infarction.
作者信息
Chen Shaomin, Li Shijia, Feng Xinheng, Wang Guisong
机构信息
Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China.
Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, Beijing, China.
出版信息
Front Cardiovasc Med. 2022 May 26;9:899302. doi: 10.3389/fcvm.2022.899302. eCollection 2022.
BACKGROUND
Repeated remote ischemic conditioning (RIC) after myocardial infarction (MI) has been shown to improve left ventricular (LV) remodeling in the experimental studies, but its cardioprotective effect in patients with ST-segment elevation myocardial infarction (STEMI) is still unknown.
OBJECTIVE
To investigate whether repeated RIC started early after primary percutaneous coronary intervention (PCI) can improve LV function in patients with STEMI.
METHODS
Patients with STEMI treated by primary PCI were included and randomized to the repeated RIC group ( = 30) or the control group ( = 30). RIC was started within 24 h after PCI and repeated daily for 1 week, using an Auto RIC device. 3D speckle-tracking echocardiography (STE) was used to assessed LV function. The primary study endpoint was the change in LV global longitudinal strain (GLS) from baseline to 1 month after PCI.
RESULTS
The repeated RIC group and the control group were well-matched at baseline including mean GLS (-9.8 ± 2.6% vs. -10.1 ± 2.5%, = 0.62). Despite there was no significant difference in mean GLS at 1 month between the two groups (-11.9 ± 2.1% vs. -10.9 ± 2.7%, = 0.13), the mean change in GLS from baseline to 1 month was significantly higher in the treatment group than in the control group (-2.1 ± 2.5% vs. -0.8 ± 2.3%, = 0.04). There were no significant differences in the changes in global circumferential strain (GCS), global area strain (GAS), global radial strain (GRS), LV ejection fraction (LVEF), LV end-diastolic volume (LVEDV), and LV end-systolic volume (LVESV) between the two groups. Peak creatine kinase isoenzyme-MB, peak high-sensitivity troponin T, and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) levels at 24 h after PCI did not differ significantly between the two groups, but NT-proBNP levels at 1 week were significantly lower in the treatment group than in the control group [357.5 (184.8-762.8) vs. 465.0 (305.8-1525.8) pg/ml, = 0.04].
CONCLUSION
Daily repeated RIC started within 24 h after PCI can improve GLS and reduce plasma NT proBNP levels in patients with STEMI.
背景
心肌梗死（MI）后重复进行远程缺血预处理（RIC）已在实验研究中显示可改善左心室（LV）重构，但其对ST段抬高型心肌梗死（STEMI）患者的心脏保护作用仍不清楚。
目的
探讨在直接经皮冠状动脉介入治疗（PCI）后早期开始重复RIC是否能改善STEMI患者的左心室功能。
方法
纳入接受直接PCI治疗的STEMI患者，并随机分为重复RIC组（n = 30）或对照组（n = 30）。在PCI后24小时内开始RIC，并使用自动RIC设备每天重复进行1周。采用三维斑点追踪超声心动图（STE）评估左心室功能。主要研究终点是PCI后1个月时左心室整体纵向应变（GLS）相对于基线的变化。
结果
重复RIC组和对照组在基线时匹配良好，包括平均GLS（-9.8±2.6%对-10.1±2.5%，P = 0.62）。尽管两组在1个月时的平均GLS无显著差异（-11.9±2.1%对-10.9±2.7%，P = 0.13），但治疗组从基线到1个月时GLS的平均变化显著高于对照组（-2.1±2.5%对-0.8±2.3%，P = 0.04）。两组在整体圆周应变（GCS）、整体面积应变（GAS）、整体径向应变（GRS）、左心室射血分数（LVEF）、左心室舒张末期容积（LVEDV）和左心室收缩末期容积（LVESV）的变化方面无显著差异。PCI后24小时时两组的肌酸激酶同工酶-MB峰值、高敏肌钙蛋白T峰值和血浆N末端脑钠肽前体（NT-proBNP）水平无显著差异，但治疗组1周时的NT-proBNP水平显著低于对照组[357.5（184.8 - 762.8）对465.0（305.8 - 1525.8）pg/ml，P = 0.04]。
结论
PCI后24小时内每天重复进行RIC可改善STEMI患者的GLS并降低血浆NT-proBNP水平。
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