Timofeeva T M, Kobalava Z D, Safarova A F, Cabello Montoya F
People's Friendship University of Russia (RUDN University).
Vinogradov City Clinical Hospital.
Ter Arkh. 2023 May 31;95(4):296-301. doi: 10.26442/00403660.2023.04.202159.
To assess the joint prognostic value of periprocedural dynamics of the left ventricular ejection fraction (PPD of LVEF) and subclinical pulmonary congestion during lung stress ultrasound in patients with first acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI) in relation to the development of heart failure (HF) in the postinfarction period.
Our prospective, single-centre, observational study included 105 patients with a first MI with no HF in the anamnesis and successful PCI. All patients underwent standard clinical and laboratory tests, NT-proBNP level assessment, echocardiography, lung stress ultrasound with a 6-minute walk test. All patients had no clinical signs of heart failure at admission and at discharge. Criteria for PPD of LV EF: improvement in LV EF≥50%; ∆LV EF more than 5%, but LV EF<50%. According to the results of lung stress ultrasound, pulmonary congestion was diagnosed: mild (2-4 B-lines), moderate (5-9 B-lines) and severe (≥10 B-lines). The end point was hospitalization for HF for 2.5 years.
Upon admission, LV EF of 50% or more was registered in 45 patients (42.9%). Positive PPD was registered in 31 (29.5%) patients. After stress ultrasound of the lungs, 20 (19%) patients had mild subclinical pulmonary congestion, 38 (36%) moderate and 47 (45%) severe according to the criteria presented. During the observation period, patients with no PPD of LVEF were significantly more likely to be hospitalized for the development of HF (in 44.4% of cases) compared with patients with positive PPD (in 15.2% of cases) and with initial LV EF≥50% (in 13.4% of cases; =0.005). When performing logistic regression analysis, the best predictive ability was found in the combination of the absence of PPD of LV EF and the sum of B-lines ≥10 on exercise (relative risk 7.45; 95% confidence interval 2.55-21.79; <0.000).
Evaluation of the combination of PPD of LV EF and the results of stress lung ultrasound at discharge in patients with first AMI and successful PCI with no HF in anamnesis allows us to identify a high-risk group for the development of HF in the postinfarction period.
评估首次急性心肌梗死（AMI）并接受经皮冠状动脉介入治疗（PCI）的患者在肺负荷超声检查期间左心室射血分数的围手术期动态变化（LVEF的PPD）和亚临床肺淤血与心肌梗死后心力衰竭（HF）发生发展的联合预后价值。
我们的前瞻性、单中心观察性研究纳入了105例既往无HF病史且首次发生心肌梗死并成功接受PCI的患者。所有患者均接受了标准的临床和实验室检查、NT-proBNP水平评估、超声心动图检查以及6分钟步行试验下的肺负荷超声检查。所有患者入院时及出院时均无心力衰竭的临床体征。LVEF的PPD标准：LVEF改善≥50%；∆LVEF大于5%，但LVEF<50%。根据肺负荷超声检查结果诊断肺淤血：轻度（2 - 4条B线）、中度（5 - 9条B线）和重度（≥10条B线）。终点为2.5年内因HF住院。
入院时，45例患者（42.9%）的LVEF≥50%。31例患者（29.5%）出现阳性PPD。根据所提出的标准，肺负荷超声检查后，20例患者（19%）有轻度亚临床肺淤血，38例（36%）为中度，47例（45%）为重度。在观察期内，与阳性PPD患者（15.2%）和初始LVEF≥50%的患者（13.4%）相比，LVEF无PPD的患者因HF进展而住院的可能性显著更高（44.4%的病例；P = 0.005）。进行逻辑回归分析时，发现LVEF无PPD与运动时B线总和≥10的组合具有最佳预测能力（相对风险7.45；95%置信区间2.55 - 21.79；P<0.000）。
对首次发生AMI且成功接受PCI且既往无HF病史的患者出院时LVEF的PPD与肺负荷超声检查结果进行联合评估，能够识别出心肌梗死后发生HF的高危人群。
