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基于血管的冠状动脉功能评估预测急性心肌梗塞后30天新发的心力衰竭
Da Luo1,2,3, Hui Wu4,5, Wenjie Zhou1,2,3
1Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.
ESC heart failure
|July 17, 2023
概括
在ST段升高心肌梗塞 (STEMI) 的初级穿皮冠状动脉干预 (PPCI) 后的冠状动脉流速 (CFV) 预测心力衰竭 (HF). 低CFV (<17.4厘米/秒) 表示高HF风险,即使恢复了上心流.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 心血管生理学心血管生理学
背景情况:
- 在ST段升高后的心肌梗塞 (STEMI),尽管初级皮肤穿冠状动脉干预 (PPCI) 成功,但仍然是心力衰竭 (HF) 的重要原因.
- 当前的评估方法可能无法完全捕捉导致不良结果的微血管功能障碍.
研究的目的:
- 评估基于血管的冠状动脉功能评估在确定亚最佳输液和预测PPCI后STEMI患者的结果方面的临床影响.
- 确定定量流量比 (QFR),血管性微血管阻力 (AMR) 和冠状动脉流速 (CFV) 在新发性HF风险分层中的作用.
主要方法:
- 从中国STEMI PPCI注册试验中对942名STEMI患者进行了回顾性分析,这些患者在PPCI后实现了心肌梗塞 (TIMI) 3级流动中血栓溶解.
- 计算心脏病相关动脉的术后QFR,AMR和CFV.
- 卡普兰-梅尔分析,考克斯回归和接收器操作特征 (ROC) 曲线分析,以评估功能参数和30天新发性高频率之间的关联.
主要成果:
- 结合低QFR和高AMR (QFR+/AMR+) 的患者的HF发病率 (27.3%) 与最佳参数 (QFR-/AMR-,10.5%) 的患者相比显著更高.
- 较高的CFV (≥17.4厘米/秒) 与较低的CFV (<17.4厘米/秒,16.8%) 相比,与较低的HF发病率 (10.3%) 相关.
- 后PPCI CFV是STEMI HF后的独立预测因素 (调整后的危险比:0.61;P=0.012),预测模型的ROC面积在0.749的曲线下.
结论:
- 冠状动脉流速 (CFV) 作为冠状动脉生理学的综合测量,反映了表心和小循环功能.
- 在PPCI后CFV<17.4厘米/秒的STEMI患者面临高风险的新发性HF,不管TIMI 3流量实现.
- 立即的血管基冠状动脉功能评估,特别是CFV,是评估低于最佳 perfusion 和分层 HF 风险后STEMI 的一个有价值的工具.
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