Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark; Faculty of Health Science, University of Copenhagen.
Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark.
Am J Cardiol. 2023 Jan 1;186:43-49. doi: 10.1016/j.amjcard.2022.10.022. Epub 2022 Nov 4.
Mounting evidence shows that right ventricle (RV) function carries independent prognostic influence in various disease states. This study aimed to investigate the incidence and impact of permanent RV infarction in patients with inferior ST-segment elevation myocardial infarction (STEMI) and culprit lesion in the right coronary artery (RCA). In this substudy of the DANAMI-3 (DANish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction) trial, cardiac magnetic resonance was performed in 291 patients at day 1 and follow-up 3 months after primary percutaneous coronary intervention of 674 patients with STEMI with the culprit lesion in the RCA. Final infarct was assessed using late gadolinium enhancement on cardiac magnetic resonance at 3 months. Patients with permanent RV infarction (20%) had lower ventricular function at follow-up; RV ejection fraction (EF) 47% ±6 versus 50% ± 5 (p <0.005) and left ventricular (LV) EF 56% ± 8 versus 60% ± 9 (p <0.006). Furthermore, patients with permanent RV infarction had a higher incidence of microvascular obstruction 39 (67%) versus 81 (39%) (p <0.001), larger final LV infarct size 16% ±8 versus 10% ± 8 (p <0.001) and larger LV area at risk 33% ± 10 versus 29% ± 9 (p <0.001). Permanent RV infarction was an independent predictor of final LV infarct size (p <0.001) but was not associated with LVEF (β = -0.0; p = 0.13) in multivariable analyses. In conclusion, permanent RV infarction was seen in 20% of patients with inferior STEMI and culprit lesion in RCA and independently predicted final LV infarct size. However, permanent RV infarction did not predict overall LV function. LGE was used to detect infarct location and quantify infarct size. LGE in RV free wall on follow-up CMR was considered as permanent infarction. LGE images were obtained 10 minutes after intravenous injection of 0.1-mmol/kg body weight of gadolinium-based contrast (Gadovist; Bayer Schering, Berlin, Germany) using an electrocardiogram (ECG)-triggered inversion-recovery sequence. The inversion time was adjusted to null the signal from the normal myocardium. Short-axis images were acquired from the atrioventricular plane to the apex with adjacent 8-mm slices. The remaining protocol has been described previously..
越来越多的证据表明，右心室（RV）功能在各种疾病状态下具有独立的预后影响。本研究旨在探讨下壁 ST 段抬高型心肌梗死（STEMI）患者中右冠状动脉（RCA）罪犯病变永久性 RV 梗死的发生率和影响。在 DANAMI-3（丹麦急性 ST 段抬高型心肌梗死最佳治疗研究）试验的这项亚研究中，对 674 例接受经皮冠状动脉介入治疗的 STEMI 患者（罪犯病变在 RCA）中的 291 例患者在第 1 天和 3 个月随访时进行心脏磁共振检查。使用心脏磁共振的晚期钆增强在 3 个月时评估最终梗死。永久性 RV 梗死（20%）患者在随访时的心室功能较低；RV 射血分数（EF）为 47%±6，而 50%±5（p<0.005）；左心室（LV）EF 为 56%±8，而 60%±9（p<0.006）。此外，永久性 RV 梗死患者的微血管阻塞发生率更高，分别为 39（67%）例和 81（39%）例（p<0.001）；最终 LV 梗死面积更大，分别为 16%±8和 10%±8（p<0.001）；LV 危险区面积更大，分别为 33%±10和 29%±9（p<0.001）。永久性 RV 梗死是最终 LV 梗死面积的独立预测因子（p<0.001），但在多变量分析中与 LVEF 无关（β= -0.0；p=0.13）。总之，下壁 STEMI 和 RCA 罪犯病变患者中 20%存在永久性 RV 梗死，且独立预测最终 LV 梗死面积。然而，永久性 RV 梗死并未预测整体 LV 功能。LGE 用于检测梗死部位和量化梗死面积。随访 CMR 时 RV 游离壁上的 LGE 被认为是永久性梗死。使用心电图（ECG）触发反转恢复序列，在静脉注射 0.1mmol/kg 体重的钆基对比剂（Gadovist；拜耳先灵，柏林，德国）后 10 分钟获得 LGE 图像。反转时间调整为使正常心肌信号为零。从房室平面到心尖获取短轴图像，相邻 8mm 切片。其余方案已在前文描述。
