Positive effect of intravenous iron-oxide administration on left ventricular remodelling in patients with acute ST-elevation myocardial infarction - A cardiovascular magnetic resonance (CMR) study
Positive effect of intravenous iron-oxide administration on left ventricular remodelling in patients with acute ST-elevation myocardial infarction - A cardiovascular magnetic resonance (CMR) study
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DOI：
10.1016/j.ijcard.2014.02.016
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发表时间：
2014-05-01
影响因子：
3.5
通讯作者：
Yilmaz, Ali
中科院分区：
文献类型：
--
作者：
Florian, Anca;Ludwig, Anna;Yilmaz, Ali
目的：本研究调查了静脉注射超小超顺磁氧化铁（USPIO）铁剂对 ST 段抬高型心肌梗死（STEMI）患者梗塞愈合的安全性和潜在“治疗”效果。最近显示，USPIO 给药能够改善急性 STEMI 患者心肌梗死病理特征。 材料和方法：17 名研究患者（IRON，54 +/- 9 岁，88% 男性）和 22 名匹配对照（CONTROL，57 +/- 9 岁，77% 男性）均患有原发性再灌注 STEMI，在急性 MI 后第一周和三个月内接受了多参数 CMR 研究。只有 IRON 患者在急性心肌梗死后四天内接受单次静脉推注 510 mg 元素铁作为 ferumoxytol (Feraheme(TM))。 结果：三个月后，所有患者均存活，且未出现不良心脏事件。随访时两组患者左心室 (LV) 射血分数均显着改善（IRON：53 +/- 10% 至 59 +/- 9%，p= 0.002；对照组：54 +/- 6% 至 57 +/- 10%，p = 0.005）以及梗塞面积缩小。 IRON 组的梗死面积有更明显的减少（IRON：-10.3 +/- 5.4% 对比对照组：-7.0 +/- 8.4%，p = 0.050），此外，IRON 组患者的心内膜范围和透壁性梗死发生率均显着下降，而对照组则没有。仅在 IRON 组中观察到左心室收缩末期容积显着下降（71 +/- 25 mL 至 59 +/- 25 mL，p = 0.002）。结论：急性 STEMI 患者静脉注射铁剂似乎与梗塞愈合改善和有益的整体左心室重塑相关。这些发现加上良好的安全性，使基于 USPIO 的铁剂给药成为急性心肌梗死管理中“诊断”和“治疗”辅助解决方案的一个有前途的候选方案。 (c) 2014 Elsevier Ireland Ltd. 保留所有权利。
Objectives: This study investigated the safety profile and potential " therapeutic" effect of intravenous ultrasmall superparamagnetic iron-oxide (USPIO)-based iron administration regarding infarct healing in patients with ST-elevation myocardial infarction (STEMI). USPIO-administration was recently shown to enable an improved characterization of myocardial infarct pathology in acute STEMI patients.Materials and Methods: Seventeen study patients (IRON, 54 +/- 9 yrs, 88% male) and 22 matched controls (CONTROL, 57 +/- 9 yrs, 77% male) both with primary reperfused STEMI underwent multi-parametric CMR studies in the first week and three months after acute MI. Only IRON patients received a single intravenous bolus of 510 mg elemental iron as ferumoxytol (Feraheme(TM)) within four days following acute MI.Results: Threemonths later, all patientswere alive and therewere no adverse cardiac events. Significant improvement in left ventricular (LV) ejection fraction (IRON: 53 +/- 10% to 59 +/- 9%, p= 0.002; CONTROL: 54 +/- 6% to 57 +/- 10%, p = 0.005) as well as shrinkage of infarct size were seen in both groups at follow-up. There was a more pronounced decrease in infarct size in the IRON group (IRON: -10.3 +/- 5.4% vs. CONTROL: -7.0 +/- 8.4%, p = 0.050) in addition to a significant decrease in both endocardial extent and prevalence of transmural infarctions in IRON but not in CONTROL patients. A significant decrease in LV end systolic volumewas only seen in the IRON group (71 +/- 25 mL to 59 +/- 25 mL, p = 0.002).Conclusions: Intravenous iron administration in acute STEMI patients seems to be associated with an improved infarct healing and a beneficial global left ventricular remodelling. These findings together with the good safety profile make USPIO-based iron administration a promising future candidate as a "diagnostic" and "therapeutic" adjunctive solution in acute MI management. (c) 2014 Elsevier Ireland Ltd. All rights reserved.