急性心肌梗死再灌注相关性出血对心室重塑和心律失常的影响

The effect of reperfusion-associated bleeding on ventricular remodeling and arrhythmia in acute myocardial infarction

目的探究对于急性心肌梗死(AMI)患者行经皮冠状动脉介入术(PCI)治疗后心肌间质出血对心室重塑及室性心律失常的影响.方法选择2019年8月至2020年12月急性ST段抬高型心肌梗死患者74例.所有患者均接受PCI治疗,术后2天及3个月时行心脏磁共振检查(CMR),心肌出血定义为在T2W和T2影像上的危险区域(AAR)内均表现为低信号.获得所有患者3个月时的信号平均心电图,评价再灌注心肌出血对心室重塑及心律失常的影响.结果46例患者存在微血管阻塞(MVO)的表现,在T2W成像中25例在AAR区域内显示为低信号,其中18例患者在T2成像上显示出心肌出血证据.将其分为A组(再灌注出血,n=18)、B组(仅MVO,n=28)、C组(无MVO或出血,n=28).基线及3个月时A组患者的左心室舒张末期容积(LVEDV)和左心室收缩末期容积(LVESV)增加,而射血分数(LVEF)降低(P<0.05),出血性心肌梗死还与较大的危险区域和梗死面积有关,可挽救的心肌百分比降低(P<0.05).出血是心肌不良重塑的独立预测因子(OR=1.48,P=0.001),同时随访3个月心电图上滤波后的QRS时限(fQRS)延长(OR=1.16,P=0.020).结论急性心肌梗死再灌注后发生心肌出血较为常见,其与心室不良重塑显著相关,且信号平均心电图检查中显示fQRS持续时间显著延长,提示患者发生心律失常的风险显著增加.

Objective To explore the effect of myocardial interstitial hemorrhage on ventricular remodeling and ventricular arrhythmia after percutaneous coronary intervention(PCI)in patients with acute myocardial infarction(AMI).Methods The study period was from August 2019 to December 2020.The subjects of the study were 74 patients with acute ST-segment elevation myocardial infarction who came to our hospital during this period.All patients received PCI treatment.Cardiovascular magnetic resonance(CMR)was performed 2 days and 3 months after surgery.Myocardial hemorrhage was defined as low signal in the AAR on the T_(2)W and T_(2) images.Obtain the average signal electrocardiogram of all patients at 3 months to evaluate the effect of reperftision nlyocardial hemorrhage on ventricular remodeling and arrhythmia.Results 46 patients presented with microvascular obstruction(MVO),25 patients was defined as low signal in the AAR on the T2 images,and 18 of them showed the evidence of myocardial bleeding.The patients were divided into group A(reperfusion bleeding,18)and group B(MVO only,n=28),C group(no MVO or bleeding,n=28)three groups.At baseline and 3 months,the left ventricular end diastolic vohime(LVEDV)and left ventricular end systolic volunie(LVESV)of group A patients increased significandy,while the ejection fraction(LVEF)decreased significantly(P<0.05),hemorrhagic myocardial infarction was also related to the larger risk area and infarct size,and the percentage of salvage myocardium was significantly reduced(P<0.05).Bleeding was an independent predictor of poor myocardial remodeling(OR=1.48,P=0.001),and the filtered QRS time limit(fQRS)on the ECG was prolonged(OR=1.16,P=0.020)at the same time of follow-up for 3 months.Conclusion The occurrence of myocardial hemorrhage after acute myocardial infarction and reperfusion is relatively common,which is significantly related to ventricular dysfunctional remodeling,and the average signal electrocardiogram examination shows that the duration of fQRS is significantly prolonged,suggesting that the risk of arrhythmia in patients is significantly increased.