Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Acta Anaesthesiol Scand. 2023 Jul;67(6):746-754. doi: 10.1111/aas.14234. Epub 2023 Mar 23.
Left ventricular (LV) dysfunction is estimated to occur in 10%-25% of the general intensive care unit (ICU) population and is frequently seen as regional wall motion abnormalities (RWMAs). Although RWMA is mostly attributed to myocardial ischemia or infarction, some studies have suggested that nonischemic RWMA might also be prevalent. We sought to establish that RWMA can be seen in critically ill patients with normal coronary arteries and to explore reasons for RWMA in this population.
In this retrospective study, data from the hospital angiography register and the ICU register were collated between 2012 and 2019. Patients were identified who underwent angiography in conjunction with their ICU stay and had RWMA on echocardiography. Patients were divided into either those with non-obstructed or those with obstructed coronary arteries. Cardiac magnetic resonance imaging (cMRI) examinations were reviewed if they had been performed on patients with non-obstructed coronaries.
We identified 53 patients with RWMA and non-obstructed coronary arteries and 204 patients with RWMA and obstructed coronary arteries. Patients with non-obstructed coronary arteries were more often female, younger, and had fewer cardiovascular risk factors. They less commonly had ST elevation, but more frequently had T-wave inversion or serious arrhythmias. Troponin levels were higher in patients with obstructed coronary arteries, but NT-proBNP was similar between the groups. There were no differences in risk-adjusted 90-day mortality between patients with non-obstructed versus obstructed coronary arteries (OR 1.21, [95% CI 0.56-2.64], p = .628). In those with non-obstructed coronary arteries, follow-up echocardiography was available for 38 patients, of whom 30 showed normalization of cardiac function. Of the 14 patients with non-obstructed coronary arteries on whom cMRI was performed, 7 had a tentative diagnosis of Takotsubo syndrome or myocardial stunning; 4 had a myocardial infarction (preexisting in 3 cases); 1 patient had acute myocarditis; 1 patient had post-myocarditis; and 1 patient was diagnosed with dilated cardiomyopathy.
RWMA can be seen to occur in critically ill patients in the absence of coronary artery obstruction. Several conditions can cause regional hypokinesia, and cMRI is useful to evaluate the underlying etiology.
左心室（LV）功能障碍估计在普通重症监护病房（ICU）人群中发生 10%-25%，并且经常表现为局部壁运动异常（RWMA）。尽管 RWMA 主要归因于心肌缺血或梗塞，但一些研究表明，非缺血性 RWMA 也可能很常见。我们试图确定 RWMA 可以在冠状动脉正常的危重病患者中看到，并探讨该人群中 RWMA 的原因。
在这项回顾性研究中，我们整理了 2012 年至 2019 年期间医院血管造影登记处和 ICU 登记处的数据。我们确定了在 ICU 住院期间接受血管造影检查且超声心动图显示 RWMA 的患者。患者分为冠状动脉无阻塞或冠状动脉阻塞。如果对冠状动脉无阻塞的患者进行了心脏磁共振成像（cMRI）检查，则对其进行了回顾。
我们确定了 53 例 RWMA 伴非阻塞性冠状动脉和 204 例 RWMA 伴阻塞性冠状动脉患者。冠状动脉无阻塞的患者更常为女性、年龄较小且心血管危险因素较少。他们不太常出现 ST 段抬高，但更常出现 T 波倒置或严重心律失常。阻塞性冠状动脉患者的肌钙蛋白水平较高，但两组间 NT-proBNP 相似。冠状动脉无阻塞与阻塞患者的风险调整后 90 天死亡率无差异（OR 1.21，[95%CI 0.56-2.64]，p=0.628）。在冠状动脉无阻塞的患者中，38 例患者可进行随访超声心动图检查，其中 30 例患者心功能正常。在进行 cMRI 的 14 例冠状动脉无阻塞患者中，7 例有 Takotsubo 综合征或心肌顿抑的暂定诊断；3 例患者在之前的检查中被诊断为心肌梗死；1 例患者患有急性心肌炎；1 例患者患有心肌炎后；1 例患者被诊断为扩张型心肌病。
在没有冠状动脉阻塞的情况下，RWMA 可发生在危重病患者中。几种情况可导致局部运动减弱，cMRI 有助于评估潜在病因。
