前段st段抬高型心肌梗死中Impella对逆转心肌重构的影响：来自急性和慢性MRI结果综合分析的见解。

IF 2.1 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Expert Review of Cardiovascular Therapy Pub Date : 2025-01-01 Epub Date: 2025-03-11 DOI:10.1080/14779072.2025.2476129

Daisuke Fukamachi, Akimasa Yamada, Kurara Takahashi, Ran Sumida, Yudai Tanaka, Shohei Migita, Saki Mizobuchi, Masatsugu Miyagawa, Hidesato Fujito, Yutaka Koyama, Akihito Oogaku, Katsunori Fukumoto, Riku Arai, Yasunari Ebuchi, Masaki Monden, Tomoyuki Morikawa, Takashi Mineki, Keisuke Kojima, Nobuhiro Murata, Mitsumasa Sudo, Daisuke Kitano, Naoya Matsumoto, Yasuo Okumura

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引用次数: 0

摘要

背景：ST段抬高型心肌梗死（STEMI）后的晚期不良心肌重构与心源性死亡密切相关。总体纵向应变（GLS）和周向舒张应变率（CDSR）衍生的心血管磁共振成像（CMRI）是晚期心肌重构的有力预测指标。然而，STEMI后Impella对CMRI的影响尚不完全清楚。研究设计和方法：我们回顾性比较STEMI后急性期（18[14-22]天和14[6-22]天，p = 0.43）和慢性期（118[102-242]天和117[101-202]天，p = 1.0）的CMRI。结果：5例患者在经皮冠状动脉介入治疗（PCI）前接受了Impella， 7例患者接受了主动脉内球囊泵送（IABP）。两组患者入院时的峰值肌酸激酶水平（2595 [2069 -12,932]vs. 4372 [2941-5601] IU/L, p = 0.76）和LVEF（51±11 vs. 50±9%,p = 1.0）无显著差异。Impella组的急性cmri源性LVEF（49±10比35±7%，p = 0.02）和CDSR（0.9±0.2比0.5±0.3 s- 1, p = 0.018）明显优于Impella组。在慢性期，Impella组cmri源性LVEF和GLS显著高于对照组(54±9比39±5%，p = 0.01；-9.9±1.3 vs -6.5±2.2%,p = 0.01)。结论：与IABP相比，Impella植入在急性期可改善LVEF和CDSR，在慢性期可更好地维持LVEF和GLS。

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Impella effects on reverse myocardial remodeling in anterior ST-elevation myocardial infarction: insights from a comprehensive analysis of acute and chronic MRI findings.

Background: Late adverse myocardial remodeling after ST elevation myocardial infarction (STEMI) is strongly associated with cardiac death. Global Longitudinal strain (GLS) and circumferential diastolic strain rate (CDSR) derived cardiovascular magnetic resonance imaging (CMRI) is a powerful predictor of late myocardial remodeling. However, the Impella's effects on CMRI after STEMI are not fully understood.

Research design and methods: We retrospectively compared the CMRI in the acute (18 [14-22] vs. 14 [6-22] days, p = 0.43) and chronic phases (118 [102-242] vs. 117 [101-202] days, p = 1.0) after anterior STEMI.

Results: Five patients received Impella before percutaneous coronary intervention (PCI), and seven underwent intra-aortic balloon pumping (IABP). There were no significant differences in the peak creatine kinase levels (2595 [2069 -12,932] vs. 4372 [2941-5601] IU/L, p = 0.76) and LVEF upon admission (51 ± 11 vs. 50 ± 9%, p = 1.0). The Impella group had significantly better acute CMRI-derived LVEF (49 ± 10 vs. 35 ± 7%, p = 0.02) and CDSR (0.9 ± 0.2 vs. 0.5 ± 0.3 s^{- 1}, p = 0.018). In the chronic phase, the CMRI-derived LVEF and GLS were significantly higher in the Impella group (54 ± 9 vs. 39 ± 5%, p = 0.01; -9.9 ± 1.3 vs. -6.5 ± 2.2%, p = 0.01).

Conclusions: The Impella implantation led to better LVEF and CDSR in the acute phase than IABP and better maintenance of both the LVEF and GLS through the chronic phase.

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来源期刊

Expert Review of Cardiovascular Therapy CARDIAC & CARDIOVASCULAR SYSTEMS-

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3.70

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期刊介绍： Expert Review of Cardiovascular Therapy (ISSN 1477-9072) provides expert reviews on the clinical applications of new medicines, therapeutic agents and diagnostics in cardiovascular disease. Coverage includes drug therapy, heart disease, vascular disorders, hypertension, cholesterol in cardiovascular disease, heart disease, stroke, heart failure and cardiovascular surgery. The Expert Review format is unique. Each review provides a complete overview of current thinking in a key area of research or clinical practice.