Arnautu Diana-Aurora, Andor Minodora, Buz Bogdan-Flaviu, Tomescu Mirela-Cleopatra, Vacarescu Cristina, Crisan Simina, Gaita Dan, Luca Constantin-Tudor, Cozma Dragos
Department of Cardiology, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania.
Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania.
Life (Basel). 2022 Oct 19;12(10):1636. doi: 10.3390/life12101636.
(1) Acute myocardial infarction (AMI) patients are at risk of left ventricular (LV) remodeling and heart failure (HF), even after successful revascularization by percutaneous coronary intervention (PCI). We wanted to assess the independent predictors of these outcomes in AMI patients. (2) Methods: The study enrolled patients with a LVEF ≥50% after a successful PCI for their first AMI. After 24 months, patients were separated into two groups based on whether their LVEF remained ≥50% (group I), or decreased to <50% (group II). (3) Outcomes: 26% of the patients experienced a decrease in LVEF below 50%, 41% showed LV remodeling, and 8% had experienced HF hospitalizations. HF hospitalizations were significantly more frequent in group II patients (p < 0.0001). The Killip class at admission >2, infarct-related longitudinal strain ≤−12.5%, and the presence of LV remodeling were identified as independent predictors of HF hospitalizations. (4) Conclusions: About 26% of AMI patients with normal LV function after a successful PCI developed HF. More sensitive techniques are required that allow for a more efficient risk-stratification and preventive therapy to reduce LV remodeling and HF in AMI patients with LVEF ≥50% after a successful PCI. The detection of abnormal ventricular deformation patterns after PCI by speckle-tracking echocardiography might be a valuable method in this approach.
（1）急性心肌梗死（AMI）患者即使在经皮冠状动脉介入治疗（PCI）成功实现血运重建后，仍有发生左心室（LV）重构和心力衰竭（HF）的风险。我们希望评估AMI患者这些结局的独立预测因素。（2）方法：该研究纳入首次发生AMI且PCI成功后左心室射血分数（LVEF）≥50%的患者。24个月后，根据患者LVEF是否仍≥50%（I组）或降至<50%（II组）将患者分为两组。（3）结局：26%的患者LVEF降至50%以下，41%出现LV重构，8%曾因HF住院。II组患者因HF住院的频率显著更高（p<0.0001）。入院时Killip分级>2、梗死相关纵向应变≤−12.5%以及存在LV重构被确定为HF住院的独立预测因素。（4）结论：成功PCI后LV功能正常的AMI患者中约26%发生了HF。需要更敏感的技术，以便进行更有效的风险分层和预防性治疗，以减少成功PCI后LVEF≥50%的AMI患者的LV重构和HF。通过斑点追踪超声心动图检测PCI后异常的心室变形模式可能是这种方法中的一种有价值的手段。
