Functional recovery after acute myocardial infarction
Functional recovery after acute myocardial infarction
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DOI：
10.1016/j.jacc.2008.04.006
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发表时间：
2008-07-15
影响因子：
24
通讯作者：
van Rossum, Albert C.
中科院分区：
文献类型：
--
作者：
Nijveldt, Robin;Beek, Aernout M.;van Rossum, Albert C.
目的探讨急性心肌梗死（AMI）后微血管阻塞（MVO）的血管造影、心电图和钆增强心血管磁共振（CMR）特征之间的关系及其对功能恢复的预测价值。但它与微血管损伤的常用标准相比如何还不清楚，并且早期的报道在MVO的意义和程度上产生了相互矛盾的结果。方法心肌梗死溶栓（TIMI）血流分级，心肌发红分级（MBG），对60例AMI患者行直接支架置入术后的ST段恢复情况进行了评价。在血运重建后2 - 9天进行心血管磁共振，以确定首过灌注成像的早期MVO，晚期钆增强成像的晚期MVO，以及梗死面积和透壁范围。电影成像被用来确定LV容量和全球和区域功能在基线和4个月follow.Results早期和晚期MVO都与不完全ST段分辨率（p = 0.002和p = 0.01，分别），但不TIMI血流分级和MBG。在所有血管造影、心电图和CMR变量中，晚期MVO是预测随访时舒张末期容积（β = 0.53; p = 0.001）、收缩末期容积（β = 8.67; p = 0.001）和射血分数（β = 3.94; p = 0.006）变化的最强参数。局部分析显示，晚期MVO对心肌梗死的透壁范围有更高的诊断价值（OR：0.18; p < 0.0001）。结论在AMI血运重建后，晚期MVO比包括透壁范围在内的所有其他特征更能预测整体和局部功能的恢复。
Objectives We examined the relation between angiographic, electrocardiographic, and gadolinium-enhanced cardiovascular magnetic resonance (CMR) characteristics of microvascular obstruction (MVO), and their predictive value on functional recovery after acute myocardial infarction ( AMI).Background Microvascular obstruction on CMR has been shown to predict left ventricular (LV) remodeling, but it is not well known how it compares with commonly used criteria of microvascular injury, and earlier reports have produced conflicting results on the significance and extent of MVO.Methods Thrombolysis In Myocardial Infarction (TIMI) flow grade, myocardial blush grade (MBG), and ST-segment resolution were assessed in 60 patients with AMI treated with primary stenting. Cardiovascular magnetic resonance was performed between 2 and 9 days after revascularization to determine early MVO on first-pass perfusion imaging, late MVO on late gadolinium-enhanced imaging, and infarct size and transmural extent. Cine imaging was used to determine LV volumes and global and regional function at baseline and 4-month follow-up.Results Early and late MVO were both related to incomplete ST-segment resolution (p = 0.002 and p = 0.01, respectively), but not to TIMI flow grade and MBG. Of all angiographic, electrocardiographic, and CMR variables, late MVO was the strongest parameter to predict changes in end-diastolic volume (beta = 0.53; p = 0.001), endsystolic volume ( beta = 8.67; p = 0.001), and ejection fraction ( beta = 3.94; p = 0.006) at follow-up. Regional analysis showed that late MVO had incremental diagnostic value to transmural extent of infarction (odds ratio: 0.18; p < 0.0001).Conclusions In patients after revascularized AMI, late MVO proved a more powerful predictor of global and regional functional recovery than all of the other characteristics, including transmural extent of infarction.