Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, the Netherlands.
Department of Critical Care, Maastricht University Medical Center, Maastricht, the Netherlands.
BMC Cardiovasc Disord. 2023 Jan 23;23(1):44. doi: 10.1186/s12872-023-03064-7.
Adverse systolic remodeling after ST-elevation myocardial infarction (STEMI) is associated with poor clinical outcomes. However, little is known about diastolic remodeling. The purpose of this study was to identify the factors leading to diastolic remodeling.
Echocardiography was performed during hospitalization and at 4 months follow-up in 267 non-diabetic STEMI patients from the GIPS-III trial. As parameters of diastolic remodeling we used (1.) the E/e' at 4 months adjusted for the E/e' at hospitalization and (2.) the change in E/e' between hospitalization and 4 months. Multivariable regression models correcting for age and sex were constructed to identify possible association of clinical and angiographic variables as well as biomarkers with diastolic remodeling.
Older age, female gender, hypertension, multi vessel disease, higher glucose and higher peak CK were independent predictors of higher E/e' at 4 months in a multivariable model (R:0.20). After adjustment for E/e' during hospitalization only female gender, multivessel disease and higher glucose remained predictors of E/e' at four months (R:0.40). Lower myocardial blush grade, AST and NT-proBNP were independent predictors of a higher increase of E/e' between hospitalization and at 4 months in a multivariable model (R:0.08).
Our data supports the hypothesis that female gender, multivessel coronary artery disease, and microvascular damage are important predictors of adverse diastolic remodeling after STEMI. In addition, our data suggests that older age and hypertension prior to STEMI may have contributed to worse pre-existing diastolic function.
NIH, NCT01217307. Prospectively registered on October 8th 2010, https://clinicaltrials.gov/ct2/show/NCT01217307 .
ST 段抬高型心肌梗死（STEMI）后收缩期重构与不良临床结局相关，但舒张期重构的相关因素知之甚少。本研究旨在确定导致舒张期重构的因素。
来自 GIPS-III 试验的 267 例非糖尿病 STEMI 患者在住院期间和 4 个月随访时进行了超声心动图检查。我们将（1.）校正住院时 E/e'的 4 个月时 E/e'和（2.）住院时和 4 个月时 E/e'的变化作为舒张期重构的参数。构建多变量回归模型，校正年龄和性别，以确定临床和血管造影变量以及生物标志物与舒张期重构的可能关联。
多变量模型显示，年龄较大、女性、高血压、多血管疾病、较高血糖和较高峰值 CK 是 4 个月时 E/e'较高的独立预测因素（R：0.20）。在校正住院期间的 E/e'后，仅女性、多血管疾病和较高血糖仍为 4 个月时 E/e'的预测因素（R：0.40）。较低的心肌灌注分级、AST 和 NT-proBNP 是校正住院期间和 4 个月时 E/e'增加的多变量模型中的独立预测因素（R：0.08）。
我们的数据支持以下假设：女性、多血管冠状动脉疾病和微血管损伤是 STEMI 后不良舒张期重构的重要预测因素。此外，我们的数据表明，STEMI 前的年龄较大和高血压可能导致预先存在的舒张功能恶化。
NIH，NCT01217307。于 2010 年 10 月 8 日前瞻性注册，https://clinicaltrials.gov/ct2/show/NCT01217307。
