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Impact of left ventricular hypertrophy on myocardial injury in patients with ST-segment elevation myocardial infarction.
Clinical Research in Cardiology ( IF 3.8 ) Pub Date : 2018-05-17 , DOI: 10.1007/s00392-018-1273-8
Thomas Stiermaier 1, 2 , Janine Pöss 1, 2 , Charlotte Eitel 1, 2 , Suzanne de Waha 1, 2 , Georg Fuernau 1, 2 , Steffen Desch 3 , Holger Thiele 3 , Ingo Eitel 1, 2
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BACKGROUND Left ventricular hypertrophy (LVH) has been suggested as a determinant of outcome in patients with ST-segment elevation myocardial infarction (STEMI). However, available data are inconclusive and the underlying mechanisms remain unclear. Therefore, the aim of this study was to evaluate the impact of LVH on myocardial injury and clinical outcome in a large multicenter STEMI population. METHODS Cardiovascular magnetic resonance was performed in 795 patients within 10 days after STEMI to assess left ventricular (LV) mass and parameters of myocardial injury. Gender-specific cutoff values of indexed LV mass were used to define LVH (67 g/m2 for men and 61 g/m2 for women). Rates of major adverse cardiac events (MACE) were determined at 12-month follow-up. RESULTS LVH was present in 438 patients (55%) and associated with a significantly larger infarct size [18.3% of LV mass (%LV) versus 14.0%LV; p < 0.01], a lower myocardial salvage index (47.8 versus 54.4; p < 0.01), larger extent of microvascular obstruction (0.4 versus 0%LV; p < 0.01) and lower LV ejection fraction (47.9 versus 53.2%; p < 0.01) compared to STEMI patients without LVH. The effect of LVH on LV ejection fraction, infarct size and myocardial salvage index remained statistically significant after adjustment for baseline characteristics (p < 0.01 for all). MACE rates at 12 months were numerically higher in patients with versus without LVH without reaching statistical significance (7.5 versus 5.6%; p = 0.32). CONCLUSION In STEMI patients, LVH is associated with more pronounced structural and functional alterations in CMR imaging as an indicator for adverse clinical outcomes in STEMI survivors.

中文翻译:

ST段抬高型心肌梗死患者左心室肥厚对心肌损伤的影响。

背景技术已经提出左心室肥大(LVH)作为ST段抬高型心肌梗死(STEMI)患者预后的决定因素。但是,可用数据尚无定论,其潜在机制仍不清楚。因此,本研究的目的是评估LVH对大型多中心STEMI人群的心肌损伤和临床结局的影响。方法在STEMI后10天内对795名患者进行了心血管磁共振检查,以评估左心室(LV)的质量和心肌损伤的参数。LV指数的性别特定临界值用于定义LVH(男性67 g / m2,女性61 g / m2)。在12个月的随访中确定主要不良心脏事件(MACE)的发生率。结果438例患者中有LVH(55%),其梗死面积明显更大[LV质量(%LV)的18.3%比LV的14.0%;p <0.01],较低的心肌抢救指数(47.8 vs 54.4; p <0.01),更大程度的微血管阻塞(0.4 vs 0%LV; p <0.01)和较低的LV射血分数(47.9 vs 53.2%; p <0.01) )与没有LVH的STEMI患者相比。调整基线特征后,LVH对左室射血分数,梗死面积和心肌挽救指数的影响仍具有统计学意义(所有p <0.01)。有和没有LVH的患者在12个月时的MACE率在数值上更高,没有达到统计学显着性(7.5比5.6%; p = 0.32)。结论对于STEMI患者,
更新日期:2019-11-01
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