心肌机械弥散预测行直接经皮冠状动脉介入治疗的 ST 段抬高型心肌梗死患者不良心脏重构。

Myocardial Mechanical Dispersion Predicts Adverse Cardiac Remodeling in Patients with ST Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention.

机构信息

Department of prevention and treatment of emergency conditions, L.T. Malaya Therapy National Institute of the National Academy of Medical Sciences of Ukraine, Ukraine.

Internal Medicine Department, State Medical University of Zaporozhye, Zaporozhye, Ukraine.

出版信息

Turk Kardiyol Dern Ars. 2023 Mar;51(2):119-128. doi: 10.5543/tkda.2022.31531.

DOI:10.5543/tkda.2022.31531

PMID:36916808

Abstract

OBJECTIVE

The aim of the study was to investigate whether increased left ventricular mechanical dispersion is an early predictor for adverse cardiac remodeling in ST-segment elevation myocardial infarction patients who had post-percutaneous coronary intervention thrombolysis in myocardial infarction (TIMI) ﬂow grade > 2.

METHODS

A total of 119 post-percutaneous coronary intervention ST elevation myocardial infarction patients with TIMI ﬂow grade >2 were prospectively included in the study. Left ventricular global longitudinal strain was quantiﬁed by 2-dimensional speckletracking echocardiography, and left ventricular mechanical dispersion was determined at baseline and after 1 year to assess adverse cardiac remodeling. The levels of circulating biomarkers were measured at the baseline. TIMI score and the Global Registry of Acute Coronary Events score systems were used to evaluate the prognosis of patients.

RESULTS

Patients with high quartile versus low quartile of left ventricular mechanical dispersion exerted higher Global Registry of Acute Coronary Events and TIMI score grades, left ventricular endsystolic volume, global longitudinal strain, and levels of the N-terminal fragment of brain natriuretic peptide and lower left ventricular ejection fraction. Multivariate log regression showed that N-terminal fragment of brain natriuretic peptide > 953 pg/mL, global longitudinal strain > -8%, and high quartile of left ventricular mechanical dispersion remained independent predictors for adverse cardiac remodeling. Addition of left ventricular mechanical dispersion to the N-terminal fragment of brain natriuretic peptide improved the discriminative potency of the whole model.

CONCLUSION

Measurement of left ventricular mechanical dispersion might be useful in determining the risk of adverse cardiac remodeling in post-percutaneous coronary intervention ST elevation myocardial infarction patients.

摘要

目的

本研究旨在探讨经皮冠状动脉介入治疗（PCI）后心肌梗死溶栓治疗（TIMI）血流分级＞2 的 ST 段抬高型心肌梗死（STEMI）患者中，左心室机械弥散度增加是否为心脏不良重构的早期预测指标。

方法

前瞻性纳入 119 例经 PCI 治疗的 STEMI 患者，TIMI 血流分级＞2。通过二维斑点追踪超声心动图定量测量左心室整体纵向应变，基线和 1 年后测量左心室机械弥散度，以评估心脏不良重构。基线时测量循环生物标志物水平。采用 TIMI 评分和全球急性冠状动脉事件注册评分系统评估患者预后。

结果

左心室机械弥散度高四分位与低四分位患者的全球急性冠状动脉事件注册评分和 TIMI 评分较高，左心室收缩末期容积、整体纵向应变、脑钠肽 N 末端片段水平较高，左心室射血分数较低。多变量 log 回归显示，脑钠肽 N 末端片段＞953pg/ml、整体纵向应变＞-8%和左心室机械弥散度高四分位是心脏不良重构的独立预测因素。将左心室机械弥散度加入脑钠肽 N 末端片段后，可提高整个模型的判别能力。