Heterogeneity of left ventricular remodeling after acute myocardial infarction: Results of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-3 Echo Substudy
Heterogeneity of left ventricular remodeling after acute myocardial infarction: Results of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-3 Echo Substudy
复制标题
DOI：
10.1067/mhj.2001.111260
复制
发表时间：
2001-01-01
影响因子：
4.8
通讯作者：
Nicolosi, GL
中科院分区：
文献类型：
--
作者：
Giannuzzi, P;Temporelli, PL;Nicolosi, GL
背景：急性心肌梗死后左室（LV）重构在溶栓时代仍有待明确。方法：为了评估梗死后左室重构的时间、程度和模式，614名患者参加了意大利研究小组和della Sopravvivenza工作室的心肌梗死-3回声亚组研究，分别在急性心肌梗死后24至48小时（S1）、出院时（S2）、6周（S3）和6个月（S4）接受了一系列二维超声心动图检查。结果舒张末期容积指数（EDVi）升高（P < 0.001），壁运动异常率（%WMA）降低（P < 0.001），而选择分数（EF）保持不变。19%的患者在S2期EDVi比S1期增加> ~ 20%（严重早期扩张），16%的患者在S4期比S2期扩张> ~ 20%（严重晚期扩张）。院内严重左室扩张的独立预测因子为相对较小的EDVi（比值比[OR] 0.961, 95%可信区间[Cl] 0.947 ~ 0.974, P = 0.0001）和相对较大的%WMA （OR 1.030, 95% CI 1.013 ~ 1.048, P = 0.0005）。同样，较小的出院前EDVi （OR 0.975, 95% Cl 0.963-0.987, P = 0.0001）、较大的%WMA （OR 1.026, 95% Cl 1.008-1.045, P = 0.0042）和中度至重度二尖瓣反流（OR 2.261, 95% Cl 1.03 -4.958, P = 0.0417）独立预测严重的晚期扩张。重要的是，92%的严重早期扩张患者在S4期没有进一步的扩张，91%的严重晚期扩张患者没有院内扩张。早期扩张患者的EF随时间变化不变，而晚期扩张患者的EF显著下降。结论：虽然住院时左室扩大不能预测随后的扩张和功能障碍，但随着时间的推移，晚期重构与整体心室功能的进行性恶化有关：大量WMA且出院前心室容量未显著增大的患者进行性扩张和功能障碍的风险更高。
Background Left ventricular (LV) remodeling after acute myocardial infarction has still to be clarified in the thrombolytic era.Methods To evaluate timing and the magnitude and pattern of postinfarct LV remodeling, a subset of 614 patients enrolled in the Gruppo Italiano per to Studio della Sopravvivenza nell'Infarto Miocardico-3 Echo Substudy underwent serial 2-dimensional echocardiograms at 24 to 48 hours from symptom onset (S1), at hospital discharge (S2), at 6 weeks (S3), and at 6 months (S4) after acute myocardial infarction.Results During the study period the end-diastolic volume index (EDVi) increased (P < .001) and wall motion abnormalities (%WMA) decreased (P < .001), whereas election fraction (EF) remained unchanged. Nineteen percent of patients showed a > 20% increase in EDVi at S2 compared with S1 (severe early dilation), and 16% of patients showed a > 20% dilation at S4 compared with S2 (severe late dilation). Independent predictors of severe in-hospital LV dilation were relatively small EDVi (odds ratio [OR] 0.961, 95% confidence interval [Cl] 0.947-0.974, P = .0001) and relatively large %WMA (OR 1.030, 95% CI 1.013-1.048, P = .0005). Similarly, smaller predischarge EDVi (OR 0.975, 95% Cl 0.963-0.987, P = .0001), greater %WMA (OR 1.026, 95% Cl 1.008-1.045, P = .0042), and moderate to severe mitral regurgitation (OR 2.261, 95% Cl 1.03 1-4.958, P = 0.0417) independently predicted severe late dilation. Importantly, 92% of the patients with severe early dilation did not have further dilation at S4, and 91% of patients with severe late dilation did not have in-hospital dilation. EF was unchanged over time in patients with early dilation, whereas it significantly decreased in those with late dilation.Conclusions Although in-hospital LV enlargement is not predictive of subsequent dilation and dysfunction, late remodeling is associated with progressive deterioration of global ventricular function over time: patients with extensive %WMA and not significantly enlarged ventricular volume before discharge are at higher risk for progressive dilation and dysfunction.