Circadian dependence of infarct size and left ventricular function after ST elevation myocardial infarction.
Circadian dependence of infarct size and left ventricular function after ST elevation myocardial infarction.
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DOI：
10.1161/circresaha.111.254284
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发表时间：
2012-01-06
影响因子：
20.1
通讯作者：
Traverse JH
中科院分区：
文献类型：
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作者：
Reiter R;Swingen C;Moore L;Henry TD;Traverse JH
在啮齿类动物中，缺血/再灌注（I/R）后的梗死面积表现出对冠状动脉闭塞时间的昼夜节律依赖性。目前尚不清楚是否在人类中发生类似的昼夜节律依赖性的梗死面积。确定在ST段抬高型心肌梗死（STEMI）的背景下，人类是否表现出梗死面积的昼夜节律依赖性。对1031例已知缺血时间在1 - 6小时之间的STEMI患者进行了一项回顾性分析，确定了165例动脉闭塞的患者，没有梗死前心绞痛或侧支血流的证据。缺血持续时间和血管造影的危险面积都不依赖于梗死发作的时间。我们观察到通过CK释放测量的梗死面积的范围与梗死发生的时间显著相关（p<0.0001）。最大的心肌损伤发生在1 AM缺血发作和5 AM再灌注发作，在曲线的峰值处测量的峰值CK比在谷值处记录的高82%。同样，梗死后2天内测量的左心室射血分数（LVEF）也依赖于STEMI的发作时间，峰值时的绝对LVEF比谷值时高7%以上（43% vs. 51%），（p< 0.03）。这些发现得到了一个亚组患者（n=45）的支持，这些患者接受了心脏MRI测量梗死面积和危险区测量。这项研究的结果首次证明，在人类中，心肌梗死面积和左心室功能STEMI后有一个昼夜依赖性的缺血发作的时间。
In rodents, infarct size following ischemia/reperfusion (I/R) exhibits a circadian dependence on the time of coronary occlusion. It is not known if a similar circadian dependence of infarct size occurs in humans. To determine if humans exhibit a circadian dependence of infarct size in the setting of ST-elevation myocardial infarction (STEMI). A retrospective analysis of 1031 patients with STEMI referred for primary PCI with known ischemic times between 1 and 6 hours identified 165 patients with occluded arteries on presentation without evidence of pre-infarction angina or collateral blood flow. Both ischemic duration and angiographic area-at-risk were not dependent on time of infarct onset. We observed that the extent of infarct size measured by CK release was significantly associated with time of day onset of infarction (p<0.0001). The greatest myocardial injury occurred at a 1 AM onset of ischemia and 5AM onset of reperfusion with the peak CK measured at the peak of the curve being 82% higher than that recorded at the trough. Similarly, left-ventricular ejection fraction (LVEF) measured within 2 days of infarction was also dependent on time of onset of STEMI with the absolute LVEF at peak more than 7% higher than at trough (43% vs. 51%), (p< 0.03). These findings were supported by a subgroup of patients (n=45) who underwent cardiac MRI measurements of infarct size and area-at-risk measurements. The results of this study demonstrate for the first time in humans that myocardial infarct size and left-ventricular function following STEMI have a circadian dependence on the time of day onset of ischemia.