摘要
目的应用心肌声学造影(MCE)评估急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)后冠状动脉微循环障碍(CMD)的发生情况,并探讨其对心功能的影响。方法入选2016年6月至2021年5月北京大学人民医院因STEMI住院行PCI,并于住院期间完成MCE的患者109例。根据MCE检查分为CMD组及微循环功能正常组。分析两组患者的一般临床资料、STEMI相关临床情况、冠状动脉造影及血运重建情况以及MCE资料。结果109例STEMI患者中CMD发生率为66.1%。CMD组患者与正常组相比C反应蛋白水平更高[10.0(1.3,46.2)mg/L比1.7(0.5,15.5)mg/L,P=0.029],脑钠肽水平更高[333(100,685)pg/ml比125(39,348)pg/ml,P=0.016],左心室射血分数(LVEF)更低[51.0%(43.1%,58.9%)比58.9%(51.5%,63.8%),P=0.002],左心室整体长轴应变更差[–10.8%(–8.1%,–13.6%)比–13.3%(–10.5%,–16.7%),P=0.006],节段性室壁运动异常(RWMA)比例更高(95.8%比78.4%,P=0.004),室壁运动评分指数(WMSI)更差[1.53(1.37,1.88)比1.29(1.09,1.47),P<0.001],室壁瘤发生率更高(19.4%比0,P=0.004)。且校正罪犯血管的影响后,两组患者LVEF、RWMA比例及WMSI依旧差异有统计学意义(均P<0.05)。结论与微循环功能正常组相比,STEMI后出现CMD的患者具有更高的炎性水平,室壁运动及心功能相对更差,提示不良预后。
Objective To evaluate the incidence of coronary microcirculation dysfunction(CMD)after percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI)by myocardial contrast echocardiography(MCE)and to explore its influence on cardiac function.Methods A total of 109 STEMI patients underwent PCI and completed MCE during hospitalization in Peking University People's Hospital from June 2016 to May 2021 were enrolled in our study.According to MCE,they were divided into coronary microcirculation dysfunction group(CMD group)and coronary microcirculation normal group.Clinical data including coronary angiography,PCI and MCE of the two groups were analyzed.Results CMD occurred in 72 patients(66.1%).Compared with normal group,the CMD group patients had higher level of C-reaction protein(CRP)[10.0(1.3,46.2)mg/L vs.1.7(0.5,15.5)mg/L,P=0.029];higher level of brain natriuretic peptide(BNP)[333(100,685)pg/ml vs.125(39,348)pg/ml,P=0.016];lower left ventricular ejection fraction(LVEF)[51.0%(43.1%,58.9%)vs.58.9%(51.5%,63.8%),P=0.002];poorer global longitudinal strain(GLS)[–10.8%(–8.1%,–13.6%)vs.–13.3%(–10.5%,–16.7%),P=0.006];higher incidence of regional wall motion abnormality(RWMA)(95.8%vs.78.4%,P=0.004);worse wall motion score index(WMSI)[1.53(1.37,1.88)vs.1.29(1.09,1.47),P<0.001]and higher incidence of ventricular aneurysm(19.4%vs.0.0,P=0.004).The statistical diff erences of LVEF,RWMA and WMSI between the 2 groups still existed when adjusting the infl uence of culprit vessel(all P<0.05).Conclusions Compared with normal microvascular function patients,patients who developed CMD after STEMI had higher infl ammatory levels,poorer ventricular wall movement and cardiac function,and a higher incidence of ventricular aneurysm,which suggesting adverse prognosis.
作者
王岚
马玉良
王伟民
朱天刚
靳文英
赵红
曹成富
张前
王静
WANG Lan;MA Yu-liang;WANG Wei-min;ZHU Tian-gang;JIN Wen-ying;ZHAO Hong;CAO Cheng-fu;ZHANG Qian;WANG Jing(Department of Cardiology,Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction,Center for Cardiovascular Translational Research,Peking University People’s Hospital,Beijing 100044,China)
出处
《中国介入心脏病学杂志》
2022年第1期33-37,共5页
Chinese Journal of Interventional Cardiology
基金
首都卫生发展科研专项项目(新)(首发2020-1-4031)。
关键词
ST段抬高型心肌梗死
心肌声学造影
冠状动脉微循环障碍
心功能
ST-segment elevation myocardial infarction
Myocardial contrast echocardiography
Coronary microvascular dysfunction
Cardiac function
