生长分化因子-15与急诊冠状动脉介入治疗术后患者左心室内径及舒张功能变化的相关性分析

目的前期研究发现生长分化因子15(growth-differentiation factor-15,GDF-15)与左室内径变化以及心肌缺血/再灌注损伤密切相关,旨在探讨GDF-15与接受急诊冠状动脉介入治疗的ST段抬高型心肌梗死(STEMI)患者远期左室内径及舒张功能变化的相关性。方法连续入选因STEMI于北京大学第三医院接受急诊冠状动脉介入治疗的患者87例,介入治疗前检测GDF-15水平,并于入院后完善基线超声心动图检查。出院后定期门诊随访和冠心病二级预防。平均随访时间18个月,复查超声心动图,分别计算左心室舒张末内径(LVEDD)和二尖瓣E峰速度与二尖瓣环舒张早期峰值速度比值(E/Em)的变化率。统计分析基线GDF-15与心室重构的相关性。结果患者的平均GDF-15水平为(986.48±322.99)pg/ml。超声心动图检查显示随访患者LVEDD较基线平均增加(2.68±8.82)%,E/Em较基线平均增加了(4.51±33.50)%。GDF-15与LVEDD变化率存在负相关(r=-0.514,P<0.01),与E/Em变化率存在负相关(r=-0.501,P<0.01)。以964.67pg/ml作为界值,GDF-15预测LVEDD改善趋势的敏感性为77.4%,特异性为67.9%;预测E/Em改善趋势的敏感性为76.5%,特异性为69.8%。结论 GDF-15水平可能部分预测早期完全再血管化的STEMI患者远期LVEDD及舒张功能的改善趋势。

Growth differentiation factor 15 as predictor of left ventricular dimension and diastolic function improvement in patients with primary percutaneous intervention after ST elevation myocardial infarction

Objective Left ventricular remodeling (LVR) and impaired diastolic function after ST Elevation Myocardial Infarction (STEMI)are associated with heart failure and poor outcomes Bench investigations have discovered that GDF-15 is associated with cardiac remodeling and ischemia/reperfusion injury, while the clinical value is unclear Our research aimed to find out the association between GDF-15 and long term LVR, as well as changes of diastolic function, after STEMI Methods A total of 87 consecutive STEMI patients who received primary PCI in our hospital were enrolled Serum GDF-15 was tested before PCI LVEDD and E/Em were calculated by echocardiography within 72 hours after PCI for baseline and a second time in 18 months follow up on average Results The average GDF-15 level was (986.48±322.99) pg/ml The follow up LVEDD changed by (2.68±8.82)% on average, while the E/Em changed by (4.51±33.50)% GDF-15 is negatively associated with the change of either LVEDD (r=-0.514,P<0 01) or E/Em (r=-0.501,P<0.01) GDF-15 may be used to predict the improvement trend of LVEDD (sensitivity 77.4%, specificity 67.9%) and E/Em (sensitivity 76.5%, specificity 69.8%) with the cut off of 964.67 pg/ml Conclusions GDF-15 may partly predict the long term improvement trend of LVEDD and diastolic function in STEMI patient who received early primary PCI treatment