Relationship of cardiac biomarkers and reversible and irreversible myocardial injury following acute myocardial infarction as determined by cardiovascular magnetic resonance
Relationship of cardiac biomarkers and reversible and irreversible myocardial injury following acute myocardial infarction as determined by cardiovascular magnetic resonance
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DOI：
10.1016/j.ijcard.2011.11.004
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发表时间：
2013-06-20
影响因子：
3.5
通讯作者：
Plein, Sven
中科院分区：
文献类型：
--
作者：
Mather, Adam N.;Fairbairn, Timothy A.;Plein, Sven
背景：心血管磁共振（CMR）可以准确描述心肌水肿、出血、梗死和微血管阻塞。本研究的目的是通过CMR确定心脏生物标志物与AMI后可逆性和不可逆性心肌损伤之间的关系。方法：对48例AMI患者行经皮冠状动脉介入治疗的临床资料进行分析。在就诊后第2天、第1周、第1个月和第3个月进行全面的CMR方案。以相同的时间间隔采集血液样本，分析高敏感c反应蛋白（hs-CRP）、肌钙蛋白I、n端前脑钠肽（NT-pro-BNP）和心脏型脂肪酸结合蛋白（H-FABP）。CMR终点为心肌水肿、出血和梗死程度以及左心室功能和容积。结果：多元回归分析显示，第2天hs-CRP是3个月时左室射血分数（LVEF） （p= 0.007）和左室收缩末期容积（LVESV） （p= 0.002）最强的独立预测因子。第2天肌钙蛋白I水平是3个月时梗死面积的唯一独立预测因子（p= 0.002）。出血性梗死患者在“第2天”的生物标志物水平明显较高。心肌出血患者的NT-pro-BNP水平在所有四个时间点均显著升高。结论：再灌注后2天测量的c反应蛋白是3个月时左心室重构的最强独立预测因子。出血性梗死患者的生物标志物水平升高表明，再灌注出血是更严重心肌损伤的标志，可能与不良心室重构有关。2011爱思唯尔爱尔兰有限公司版权所有。
Background: Cardiovascular magnetic resonance (CMR) can accurately depictmyocardial oedema, haemorrhage, infarction and microvascular obstruction. The purpose of this study was to establish the relationships between cardiac biomarkers and reversible and irreversible myocardial injury following AMI, as determined by CMR.Methods: Forty-eight patients admittedwith AMI and successfully treatedwith primary percutaneous coronary interventionwere studied. A comprehensive CMR protocol was performed at day 2, 1 week, 1 month and 3 months after presentation. Blood samples were taken at the same intervals and analysed for highly sensitive C-reactive protein (hs-CRP), Troponin I, N-terminal-pro-brain natriuretic peptide (NT-pro-BNP) and Heart-type fatty acid binding protein (H-FABP). The CMR end points were the extent of myocardial oedema, haemorrhage and infarction as well as left ventricular function and volumes.Results: Multiple regression analyses demonstrated that hs-CRP on 'day 2' was the strongest independent predictor of left ventricular ejection fraction (LVEF) (p= 0.007) and left ventricular end-systolic volume (LVESV) (p= 0.002) at 3 months. Troponin I level on 'day 2' was the only independent predictor of infarct size (p= 0.002) at 3 months. Patients with haemorrhagic infarctions had significantly higher biomarker levels at 'day 2'. NT-pro-BNP levels were significantly greater in patients with myocardial haemorrhage at all four time points.Conclusions: C-reactive protein measured two days after reperfusion was the strongest independent predictor of left ventricular remodelling at three months. Elevated biomarker levels in patients with haemorrhagic infarction suggest that reperfusion haemorrhage is a marker of more severe myocardial injury and may be associated with adverse ventricular remodelling. (C) 2011 Elsevier Ireland Ltd. All rights reserved.