Lazar Monika, Francuz Paweł, Podolecki Tomasz, Kowalczyk Jacek, Mitręga Katarzyna, Olma Anna, Kalarus Zbigniew, Streb Witold
Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland.
Department of Cardiology and Angiology, Silesian Center for Heart Diseases, Zabrze, Poland.
Postepy Kardiol Interwencyjnej. 2023 Sep;19(3):225-232. doi: 10.5114/aic.2023.131475. Epub 2023 Sep 27.
One indication for the implantation of a cardioverter-defibrillator is a reduction in the left ventricular ejection fraction (LVEF) ≤ 35%. However, in certain patients following an acute myocardial infarction (AMI) a gradual improvement in LVEF has been observed. The factors determining this increase in LVEF have not been conclusively determined.
To ascertain the independent predictors associated with the improvement of LVEF in patients following AMI who underwent invasive treatment, while observing their progress over a 6-month follow-up period.
Among 665 patients with AMI, a population with LVEF ≤ 35% was selected. After 6 months, a follow-up echocardiogram was performed. Further analysis compared patients with at least 5% improvement in LVEF (Group I) with those without an increase (Group II).
Group I consisted of 34 individuals out of 80 patients (43%) with LVEF ≤ 35%. The factors linked to a reduced probability of LVEF improvement were: higher levels of cardiac troponin T (cTnT) (OR 0.841 for 1 ng/ml increase in cTnT, CI 0.715-0.989; = 0.037), presence of diabetes mellitus (OR = 0.217, 95% CI: 0.058-0.813, = 0.023) and moderate or severe mitral regurgitation (OR = 0.178, 95% CI: 0.053-0.597; = 0.005).
The study findings indicate that the presence of severe or moderate mitral regurgitation is the most significant factor contributing to the lack of LVEF improvement following AMI. Moreover, the extent of myocardial damage, as indicated by elevated cTnT values, along with compromised adaptation to hypoxia in patients with diabetes, are identified as independent factors associated with reduced chances of an increase in LVEF.
植入心脏复律除颤器的一个指征是左心室射血分数（LVEF）≤35%。然而，在某些急性心肌梗死（AMI）患者中，已观察到LVEF逐渐改善。决定LVEF增加的因素尚未最终确定。
确定接受侵入性治疗的AMI患者中与LVEF改善相关的独立预测因素，同时观察他们在6个月随访期内的进展。
在665例AMI患者中，选择LVEF≤35%的人群。6个月后，进行随访超声心动图检查。进一步分析将LVEF至少提高5%的患者（第一组）与未增加的患者（第二组）进行比较。
第一组由80例LVEF≤35%的患者中的34例组成（43%）。与LVEF改善可能性降低相关的因素有：心肌肌钙蛋白T（cTnT）水平较高（cTnT每增加1 ng/ml，比值比为0.841，可信区间为0.715 - 0.989；P = 0.037）、糖尿病的存在（比值比 = 0.217，95%可信区间：0.058 - 0.813，P = 0.023）以及中度或重度二尖瓣反流（比值比 = 0.178，95%可信区间：0.053 - 0.597；P = 0.005）。
研究结果表明，中重度二尖瓣反流的存在是导致AMI后LVEF缺乏改善的最显著因素。此外，cTnT值升高所表明的心肌损伤程度，以及糖尿病患者对缺氧的适应性受损，被确定为与LVEF增加机会减少相关的独立因素。
