首次急性心肌梗死患者经皮冠状动脉介入治疗成功后右心室直径和收缩功能的变化
Changes in the Right Ventricular Diameters and Systolic Function After Successful Percutaneous Coronary Intervention in Patients With First Acute Myocardial Infarction.
作者信息
Nguyen Duy Toan, Pham Phuong Thao Anh, Nguyen Lan Hieu, Luong Cong Thuc
机构信息
Cardiovascular Center, Military Hospital 103, Hanoi, Vietnam.
Cardiovascular Department, Vietnam Military Medical University, Hanoi, Vietnam.
出版信息
Cardiol Res. 2025 Jun;16(3):212-224. doi: 10.14740/cr2046. Epub 2025 Apr 4.
BACKGROUND
Right ventricular (RV) diameters and systolic function are strong predictors of outcomes and major adverse cardiovascular events (MACEs) in acute myocardial infarction (AMI). This study evaluated RV parameters via echocardiography in AMI patients and assessed their changes 1 month after discharge.
METHODS
A prospective observational study was conducted on 133 consecutive patients with their first AMI. RV diameters and systolic function were evaluated with echocardiography within 24 h after successful percutaneous coronary intervention (PCI) and again 1 month after discharge. MACEs were evaluated during hospitalization and at 1 month post discharge.
RESULTS
Men accounted for 69.92% of the participants, with a mean age of 68 years. Reduced right ventricular free wall longitudinal strain (RVFWSL) and right ventricular four-chamber longitudinal strain (RV4CSL) were observed in 62.4% (mean -18.28±8.77%) and 83.34% (mean -14.78±6.94%) of patients, respectively. Right ventricular longitudinal strain (RVLS) was significantly lower in the ST-elevation myocardial infarction (STEMI) group and Killip III-IV patients. RV basal and mid diameters (RVD1, RVD2) were larger in right coronary artery (RCA) and left main artery (LM) lesions than in left anterior descending artery (LAD) and left circumflex artery (LCx) ones (P < 0.05). RVLS correlated significantly with body mass index (BMI), troponin I, and left ventricular ejection fraction (LVEF). After 1 month, RVFWSL and RV4CSL improved significantly, especially in patients without MACEs, Killip III-IV, and single-vessel lesions.
CONCLUSIONS
RV diameters varied with the culprit lesion and remained stable after 1 month. RVLS was significantly reduced in AMI, especially in STEMI and Killip III-IV, correlating with LVEF. After 1 month, RVLS improved faster, particularly in patients without MACEs, Killip III-IV, or single-vessel lesions.
背景
右心室（RV）直径和收缩功能是急性心肌梗死（AMI）患者预后及主要不良心血管事件（MACE）的有力预测指标。本研究通过超声心动图评估AMI患者的RV参数，并评估出院1个月后这些参数的变化。
方法
对133例首次发生AMI的连续患者进行前瞻性观察研究。在成功进行经皮冠状动脉介入治疗（PCI）后24小时内及出院1个月后，通过超声心动图评估RV直径和收缩功能。在住院期间及出院后1个月评估MACE。
结果
男性占参与者的69.92%，平均年龄为68岁。分别有62.4%（平均-18.28±8.77%）和83.34%（平均-14.78±6.94%）的患者观察到右心室游离壁纵向应变（RVFWSL）和右心室四腔纵向应变（RV4CSL）降低。ST段抬高型心肌梗死（STEMI）组和Killip III-IV级患者的右心室纵向应变（RVLS）显著降低。右冠状动脉（RCA）和左主干动脉（LM）病变患者的RV基底和中间直径（RVD1、RVD2）大于左前降支动脉（LAD）和左旋支动脉（LCx）病变患者（P<0.05）。RVLS与体重指数（BMI）、肌钙蛋白I和左心室射血分数（LVEF）显著相关。1个月后，RVFWSL和RV4CSL显著改善，尤其是在无MACE、Killip III-IV级和单支血管病变的患者中。
结论
RV直径随罪犯病变而异，1个月后保持稳定。AMI患者的RVLS显著降低，尤其是在STEMI和Killip III-IV级患者中，且与LVEF相关。1个月后，RVLS改善更快，尤其是在无MACE、Killip III-IV级或单支血管病变的患者中。
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