Cardiac structural and functional changes in ischemia-reperfusion injury of myocardium

L. Gelis, A. Miadzvedzeva, N. Shibeko, S. Kurganovich, I. Haidzel, T. T. Gevorkyan
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Abstract

   The aim is to study the effect of microvascular reperfusion injury (RI) of myocardium on structural and functional changes of heart in patients with acute coronary syndrome with ST segment elevation (STE-ACS) and endovascular revascularization.   Materials and Methods. The study included 146 patients with STE-ACS (mean age 54 ± 10 years, 89 % men). Depending on the presence of microvascular RI, according to CMR, performed on 5 ± 3 days after myocardial infarction, patients were divided into groups: the first group included 73 patients (50 %) with microvasculature lesions, the second group consisted of 73 patients (50 %) without microvasculature lesions. All patients underwent endovascular myocardial revascularization within 12 hours of symptoms onset. The assessment of structural and functional parameters of heart was performed by CMR with contrast enhancement on 5 ± 3, 30 and 90 days, by echocardiography on 1-2 days, 1, 6 and 12 months after myocardial infarction.   Results. In our study microvascular RI was accompanied by a significant size of infarction, a high transmurality index (TI), a large size of edema and a low myocardial salvage index, was associated with LV dilatation, a decrease in  global and local myocardial contractility during the 12 months post-infarction period (p < 0.05). The risk of developing pathological remodeling of left ventricle with microvascular RI size >1.2 % of LV mass is OR=6.25, 95 % CI 2.25–17.35 (p < 0.001), myonecrosis size on day 5 ± 3 of MI >11.7 % of LV mass (OR=10.1, 95 % CI 4.72–21.69, p < 0.001), TI > 64.3 (OR=5.63, 95 % CI 2.37–13.39, p < 0.001), edema size >24.7 % of LV mass (OR = 2.33, 95 % CI 1.09–4.97, p < 0.02).   Conclusion. Microvascular RI of myocardium is associated with pathological remodeling of the left ventricle.
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心肌缺血再灌注损伤后心脏结构和功能的改变
目的是研究心肌微血管再灌注损伤(RI)对急性冠状动脉综合征ST段抬高(STE-ACS)患者心脏结构和功能改变及血管内重建的影响。材料与方法。研究纳入了146例STE-ACS患者(平均年龄54±10岁,89%为男性)。根据有无微血管RI,在心肌梗死后5±3天进行CMR,将患者分为两组:第一组73例(50%)有微血管病变,第二组73例(50%)无微血管病变。所有患者均在症状出现后12小时内行血管内心肌血运重建术。心肌梗死后5±3天、30天和90天采用CMR增强,1 ~ 2天、1个月、6个月和12个月采用超声心动图评估心脏结构和功能参数。结果。在我们的研究中,微血管RI伴有明显的梗死面积,高跨壁指数(TI),大水肿和低心肌挽救指数,与左室扩张相关,梗死后12个月内整体和局部心肌收缩力下降(p < 0.05)。微血管RI大小>左室体积的1.2%时发生病理性左室重构的风险OR=6.25, 95% CI 2.25 ~ 17.35 (p < 0.001), MI第5±3天肌坏死大小>左室体积的11.7% (OR=10.1, 95% CI 4.72 ~ 21.69, p < 0.001), TI > 64.3 (OR=5.63, 95% CI 2.37 ~ 13.39, p < 0.001),水肿大小>左室体积的24.7% (OR= 2.33, 95% CI 1.09 ~ 4.97, p < 0.02)。结论。心肌微血管RI与左心室病理性重构有关。
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