急性ST段抬高型心肌梗死患者直接介入术后心肌内出血对于左心室重构的影响  

Effect of myocardial hemorrhage on left ventricular remodeling after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction

作　　者：姜子超 刘康 凌维维 钱赓[3] 冯斯婷[1] JIANG Zichao;LIU Kang;LING Weiwei;QIAN Geng;FENG Siting(Department of Emergency and Critical Care Center,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所急诊危重症中心,100029 [2]天津胸科医院 [3]解放军总医院第一医学中心心血管内科,100029

出　　处：《心肺血管病杂志》2024年第9期913-920,共8页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市保健科研课题项目(京17-11号)。

摘　　要：目的:本研究旨在探讨心肌内出血(intramural hemorrhage,IMH)对于急性ST段抬高型心肌梗死(ST elevation myocardial infarction,STEMI)直接PCI术后不良左心室重构的影响,以期为治疗和管理急性STEMI患者提供参考。方法:本研究纳入了152例行直接PCI的急性STEMI患者进行前瞻性队列观察研究,术后第1周完善心脏磁共振(cardiac magnetic resonance,CMR)检查,根据IMH出现与否将患者分为两组,入组患者术后6个月再次行CMR检查,观察两组术后6个月和术后7天CMR显示的左心室舒张末期容积(left ventricular end-diastolic volume,LVEDV)的变化并判定左心室重构情况,分析IMH与左心室重构发生的相关性。结果:前后两次CMR结果显示,IMH组6个月时LVEF无明显改善(P>0.05);而无IMH组,LVEF明显提高(P=0.045)。发生左心室重构的比例,IMH组较无IMH组更高,存在统计学差异[38.8%(26/67) vs.20.0%(17/85),P<0.05],IMH是急性STEMI患者直接PCI术后发生左心室重构的独立危险因素(P <0.05)。结论:IMH对急性STEMI患者术后6个月不良的左心室重构具有预测作用。Objective:The aim of this study was to investigate the impact of intramural hemorrhage(IMH) on adverse left ventricular remodeling following primary PCI in patients with acute ST elevation myocardial infarction(STEMI),in order to provide valuable insights for the treatment and management of patients with acute ST-elevation myocardial infarction(STEMI).Methods:A prospective cohort observational study was conducted involving 152 patients with acute STEMI undergoing direct PCI.Cardiac magnetic resonance(CMR) examination was performed within the first week post-primary PCI,and all patients were classified into two groups based on the presence or absence of IMH.Study patients was required to perform the second CMR 6 months after the primary PCI.CMR imaging was repeated at 6 months after primary PCI to observe changes in left ventricular end-diastolic volume(LVEDV) and Left ventricular remodeling was assessed,and the correlation between IMH and left ventricular remodeling was analyzed.Results:The result demonstrated that there was no significant improvement of LVEF in IMH group at 6 months after primary PCI(P>0.05),whereas,there was a significant improvement in LVEF observed in the non-IMH group(P<0.05).The proportion of left ventricular remodeling in IMH group was significantly higher compared with Non-IMH group [38.8%(26/67) vs.20.0%(17/85),P<0.05],IMH were independent risk factors for left ventricular remodeling in acute STEMI patients undergoing PCI(P<0.05).Conclusions:The IMH predicts unfavorable left ventricular remodeling at 6 months after primary PCI in patients diagnosed with acute STEMI.

关 键 词：急性ST段抬高型心肌梗死 经皮冠状动脉介入术 心肌内出血 左心室重构 

分 类 号：R54[医药卫生—心血管疾病]