Stevic Neven, Pinède Alexandre, Mewton Nathan, Ovize Michel, Argaud Laurent, Lecour Sandrine, Boiteux Clément, Bochaton Thomas, Cour Martin
Service de Médecine Intensive -Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69437, Lyon Cedex 03, France.
Faculté de Médecine Lyon-Est, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France.
Basic Res Cardiol. 2024 Dec;119(6):911-921. doi: 10.1007/s00395-024-01091-9. Epub 2024 Nov 23.
Ventricular fibrillation (VF)-induced cardiac arrest frequently complicates ST-segment elevation myocardial infarction (STEMI). Although larger infarct sizes (IS) correlate with a higher risk of VF, the influence of VF itself on IS has remained poorly investigated. To address this knowledge gap, we analyzed the effect of VF on IS in patients and two experimental models. From a prospective cohort, 30 STEMI patients with VF were matched 1:2 with STEMI patients without VF on the common determinants of IS. The primary endpoint was IS, assessed using the 48-h area under the curve (AUC) for troponin. We also compared IS in pigs with/without spontaneous VF during STEMI (n = 15/group), and in an isolated rat heart model of myocardial infarction with/without electrically induced VF (n = 7/group). After matching, the patient characteristics, including the area at risk (AR), were similar. IS was 33% lower in the VF group compared to the control group (troponin AUC 1.6 [0.5-3.3] 10 arbitrary units vs. 2.4 [0.9-4.1] 10 arbitrary units; p < 0.05), but infarct scar size (assessed using MRI and ECG) did not differ between the groups at 1 and 6 months. In both experimental models, IS, expressed as a percentage of AR, was lower (p < 0.05) in the VF group than in the control group. When common determinants of IS are comparable, VF occurring prior to myocardial infarction reperfusion appears to be associated with smaller IS. Nevertheless, this finding, observed under specific experimental conditions and in a highly selected group of patients, was not associated with reduced infarct scar size.Registration (HIBISCUS-STEMI cohort): ClinicalTrials.gov NCT05794022.
心室颤动（VF）诱发的心脏骤停常使ST段抬高型心肌梗死（STEMI）病情复杂化。尽管较大的梗死面积（IS）与VF风险较高相关，但VF本身对IS的影响仍研究不足。为填补这一知识空白，我们分析了VF对患者及两种实验模型中IS的影响。在前瞻性队列中，将30例发生VF的STEMI患者与未发生VF的STEMI患者按IS的共同决定因素进行1:2匹配。主要终点为IS，采用肌钙蛋白48小时曲线下面积（AUC）进行评估。我们还比较了STEMI期间有/无自发性VF的猪（每组n = 15）以及有/无电诱导VF的离体大鼠心肌梗死模型（每组n = 7）的IS。匹配后，包括危险面积（AR）在内的患者特征相似。VF组的IS比对照组低33%（肌钙蛋白AUC分别为1.6 [0.5 - 3.3]×10个任意单位和2.4 [0.9 - 4.1]×10个任意单位；p < 0.05），但1个月和6个月时两组间梗死瘢痕大小（采用MRI和ECG评估）无差异。在两种实验模型中，以AR百分比表示的IS，VF组均低于对照组（p < 0.05）。当IS的共同决定因素可比时，心肌梗死再灌注前发生的VF似乎与较小的IS相关。然而，这一在特定实验条件下和高度选择的患者群体中观察到的发现，与梗死瘢痕大小减小无关。注册信息（HIBISCUS - STEMI队列）：ClinicalTrials.gov NCT05794022 。
