Diana Giovanni, Locorotondo Gabriella, Manfredonia Laura, Graziani Francesca, Lombardo Antonella, Lanza Gaetano Antonio, Pedicino Daniela, Liuzzo Giovanna, Massetti Massimo, Crea Filippo
Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.
Department of Cardiovascular Sciences, University of the Sacred Heart, Rome, Italy.
Front Cardiovasc Med. 2022 Dec 19;9:997821. doi: 10.3389/fcvm.2022.997821. eCollection 2022.
In ST-segment elevation myocardial infarction (STEMI), predictors of subclinical dysfunction of remote myocardium are unknown. We prospectively aimed at identifying clinical and biochemical correlates of remote subclinical dysfunction and its impact on left ventricular ejection fraction (LVEF).
One-hundred thirty-three patients (63.9 ± 12.1 years, 68% male) with first successfully treated (54% anterior, 46% non-anterior, = 0.19) STEMI underwent echocardiography at 5 ± 2 days after onset and at 8 ± 2-month follow-up, and were compared to 13 age and sex-matched (63.3 ± 11.4) healthy controls. All 16 left ventricular (LV) segments were grouped into ischemic, border, and remote myocardium: mean value of longitudinal strain (LS) within grouped segments were expressed as iLS, bLS, rLS, respectively. LV end-diastolic (EDV), end-systolic (ESV) volumes indexed for body surface area (EDVi, ESVi, respectively), LVEF and global LS (GLS) were determined. Creatinine, glomerular filtration rate, admission level of NT-pro-brain-natriuretic peptide (NT-proBNP) and troponin peaks were considered for the analysis.
At baseline, rLS (15.5 ± 4.4) was better than iLS (12.9 ± 4.8, < 0.001), but lower than that in controls (19.1 ± 2.7, < 0.001) and similar to bLS (15 ± 5.4, = ns), and did not differ between patients with single or multivessel coronary artery disease (CAD). At multivariate regression analysis, only admission NT-proBNP levels but not peak Tn levels independently predicted rLS (β = -0.58, = 0.001), as well as iLS (β = -0.52, = 0.001). Both at baseline and at follow-up, rLS correlated to LVEF similarly to iLS and bLS ( < 0.001 for all). Median value of rLS at baseline was 15%: compared to patients with rLS ≥ 15% at baseline, patients with rLS < 15% showed lower LVEF (52.3 ± 9.4 vs. 58.6 ± 7.6, < 0.001) and GLS (16.3 ± 3.9 vs. 19.9 ± 3.2), and higher EDVi (62.3 ± 19.9 vs. 54 ± 12, = 0.009) and ESVi (30.6 ± 15.5 vs. 22.3 ± 7.6, < 0.001) at follow-up.
In optimally treated STEMI, dysfunction of remote myocardium assessed by LS: (1) is predicted by elevated NT-proBNP; (2) could be independent of CAD extent and infarct size; (3) is associated to worse LV morphological and functional indexes at follow-up.
在ST段抬高型心肌梗死（STEMI）中，远隔心肌亚临床功能障碍的预测因素尚不清楚。我们前瞻性地旨在确定远隔亚临床功能障碍的临床和生化相关性及其对左心室射血分数（LVEF）的影响。
133例首次成功治疗的STEMI患者（年龄63.9±12.1岁，男性占68%）（54%为前壁心肌梗死，46%为非前壁心肌梗死，P = 0.19）在发病后5±2天及8±2个月随访时接受超声心动图检查，并与13例年龄和性别匹配（63.3±11.4）的健康对照者进行比较。将所有16个左心室（LV）节段分为缺血心肌、边缘心肌和远隔心肌：各分组节段内纵向应变（LS）的平均值分别表示为iLS、bLS、rLS。测定左心室舒张末期（EDV）、收缩末期（ESV）容积指数（分别为EDVi、ESVi）、LVEF和整体LS（GLS）。分析时考虑肌酐、肾小球滤过率、入院时NT-前脑钠肽（NT-proBNP）水平和肌钙蛋白峰值。
基线时，rLS（15.5±4.4）优于iLS（12.9±4.8，P<0.001），但低于对照组（19.1±2.7，P<0.001），与bLS（15±5.4，P = 无显著差异）相似，单支或多支冠状动脉疾病（CAD）患者之间无差异。在多变量回归分析中，仅入院时NT-proBNP水平而非肌钙蛋白峰值水平独立预测rLS（β = -0.58，P = 0.001）以及iLS（β = -0.52，P = 0.001）。在基线和随访时，rLS与LVEF的相关性与iLS和bLS相似（均P<0.001）。基线时rLS的中位数为15%：与基线时rLS≥15%的患者相比，rLS<15%的患者在随访时LVEF较低（52.3±9.4对58.6±7.6，P<0.001）、GLS较低（16.3±3.9对19.9±3.2），EDVi较高（62.3±19.9对54±12，P = 0.009）和ESVi较高（30.6±15.5对22.3±7.6，P<0.001）。
在最佳治疗的STEMI中，通过LS评估的远隔心肌功能障碍：（1）由NT-proBNP升高预测；（2）可能独立于CAD范围和梗死面积；（3）与随访时较差的左心室形态和功能指标相关。
