Luisi Giovanni Andrea, Pestelli Gabriele, Lorenzoni Giulia, Trevisan Filippo, Smarrazzo Vittorio, Fiorencis Andrea, Flamigni Filippo, Ferrari Roberto, Mele Donato
Cardiology Unit, University Hospital of Ferrara, 44124 Ferrara, Italy.
Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy.
J Clin Med. 2022 Sep 12;11(18):5348. doi: 10.3390/jcm11185348.
Background: Measures of global left ventricular (LV) systolic function have limitations for the prediction of post-infarct LV remodeling (LVR). Therefore, we tested the association between a new measure of regional LV systolic function—the percentage of severely altered strain (%SAS)- and LVR after acute ST-elevation myocardial infarction (STEMI). As a secondary objective, we also evaluated the association between %SAS and clinical events during follow-up. Methods: Of 177 patients undergoing echocardiography within 24 h from primary percutaneous coronary angioplasty, 172 were studied for 3 months, 167 for 12 months, and 10 died. The %SAS was calculated by dividing the number of LV myocardial segments with ≥−5% peak systolic longitudinal strain by the total number of segments. LVR was defined as the increase in end-diastolic volume >20% at its first occurrence compared to baseline. Results: LVR percentage was 10.2% and 15.8% at 3 and 12 months, respectively. Based on univariable analysis, a number of clinical, laboratory, electrocardiographic and echocardiographic variables were associated with LVR. Based on multivariable analysis, %SAS and TnI peak remained associated with LVR (for %SAS 5% increase, OR 1.226, 95% CI 1.098−1.369, p < 0.0005; for TnI peak, OR 1.025, 95% CI 1.004−1.047, p = 0.022). %SAS and LVR were also associated with occurrence of clinical events at a median follow-up of 43 months (HR 1.02, 95% CI 1.0−1.04, p = 0.0165). Conclusions: In patients treated for acute STEMI, acute %SAS is associated with post-infarct LVR. Therefore, we suggest performing such evaluations on a routine basis to identify, as early as possible, STEMI patients at higher risk.
左心室（LV）整体收缩功能指标在预测心肌梗死后左心室重构（LVR）方面存在局限性。因此，我们测试了一种新的局部左心室收缩功能指标——严重应变改变百分比（%SAS）与急性ST段抬高型心肌梗死（STEMI）后LVR之间的关联。作为次要目标，我们还评估了%SAS与随访期间临床事件之间的关联。方法：在177例接受直接经皮冠状动脉介入治疗后24小时内接受超声心动图检查的患者中，172例接受了3个月的研究，167例接受了12个月的研究，10例死亡。%SAS通过将收缩期峰值纵向应变≥-5%的左心室心肌节段数除以节段总数来计算。LVR定义为首次出现时舒张末期容积较基线增加>20%。结果：3个月和12个月时LVR百分比分别为10.2%和15.8%。基于单变量分析，一些临床、实验室、心电图和超声心动图变量与LVR相关。基于多变量分析，%SAS和肌钙蛋白I峰值仍与LVR相关（%SAS增加5%，OR 1.226，95%CI 1.098 - 1.369，p < 0.0005；肌钙蛋白I峰值，OR 1.025，95%CI 1.004 - 1.047，p = 0.022）。在中位随访43个月时，%SAS和LVR也与临床事件的发生相关（HR 1.02，95%CI 1.0 - 1.04，p = 0.0165）。结论：在接受急性STEMI治疗的患者中，急性%SAS与心肌梗死后LVR相关。因此，我们建议常规进行此类评估，以尽早识别高危STEMI患者。
