• 作者：Xavier Freixa ; ^{freixa@clinic.ub.es} ; Magda Heras ; José ; T. Ortiz ; Sergio Argiró ; Eduard Guasch ; Adelina Doltra ; Marcelo Jimé ; nez ; Amadeo Betriu ; Mó ; nica Masotti
• 关键词：Endotelina ; Da&ntilde ; o de reperfusió ; n ; Microcirculació ; n ; Obstrucció ; n microvascular ; Infarto agudo de miocardio
• 刊名：Revista Espa帽ola de Cardiolog铆a
• 出版年：2011
• 期刊代码：pca308_03008932
• 类别：med
• 出版时间：February 2011
• 卷：64
• 期：2
• 页码：105-110
• 文件大小：221 K

Introduction and objectives

High endothelin-1 (ET-1) levels have been linked to poor clinical outcomes after ST-segment elevation myocardial infarction (STEMI). Vasoconstriction of the coronary microcirculation seems to be the underlying mechanism. The aim of the study was to assess the effect of ET-1 on microvascular integrity, infarct size, left ventricular ejection fraction (LVEF) and myocardial salvage in evolving myocardial infarction (MI).

Methods

We measured ET-1 levels acutely (6-24 h)聽in 127 patients presenting with their first STEMI.聽Contrast-enhanced cardiac magnetic resonance (ce-CMR) was performed in 94 patients within聽1 week聽to assess microvascular obstruction (MO), infarct size and LVEF. A myocardial salvage index (MSI) was defined as the percentage of at-risk angiographic area without necrosis on the ce-CMR.

Results

Mean age was 60.9 卤 11.8 years and 98 (77%) were males.聽Median ET-1 level within the first 24 h was 6.8 pg/mL (25^th 鈥?5^th percentile range: 5.4鈥?.5 pg/mL). Patients with ET-1 concentrations over the median presented higher percentage of MO (77.7%for ET-1 > 6.8 pg/mL vs. 16.6%for ET-1 鈮?#xA0;6.8 pg/mL, P < .001) and lower MSI values (13.8 卤 26%for ET-1 > 6.8 pg/mL vs. 37.4 (26%) for ET-1 鈮?#xA0;6.8 pg/mL, P = .02). ET-1 levels did not show a significant association with infarct size (P = .11) and LVEF (P = .16). Multivariate analysis found ET-1 to be a significant predictor of MO (OR = 2.78; CI 95%1.16-6.66; P = .021) and MSI 鈮?Percentile 25 (OR = 1.69, CI 95%1.01-2.81; P = .04).

Conclusions

High ET-1 levels after myocardial infarction are associated with the presence of聽microvascular obstruction and lower myocardial salvage index.

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