Characteristics of myocardial injury in patients with acute myocardial infarction complicated with pleural effusion and its influence on long-term prognosis

doi:10.11958/20230377

Abstract

Abstract:

Objective To explore the characteristics of myocardial injury in patients with acute myocardial infarction (AMI) complicated by pleural effusion and its effect on long-term prognosis. Methods It was a prospective single-center study. Patients with AMI who were admitted to hospital within 15 days from symptom onset and performed echocardiography and cardiac magnetic resonance imaging (CMR) during hospitalization were consecutively enrolled and assigned to the with-pleural effusion group and the without-pleural effusion group according to the echocardiography result. Baseline data, cardiac magnetic resonance myocardial injury index and echocardiography characteristics were compared between the two groups. The occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) was recorded through outpatient follow-up and telephone follow-up, including all-cause death, re-infarction, revascularization, rehospitalization for congestive heart failure and stroke. Cox regression analysis was performed to analyze influencing factors of all-cause death. Results Among 211 patients, 31 (14.7%) patients had pleural effusion and 180 (85.3%) had no pleural effusion. Compared with the group without pleural effusion, the left ventricular end-diastolic diameter was larger, and left ventricular ejection fraction assessed by echocardiography was lower in the group with pleural effusion (P<0.05). There were no significant differences in infarct size, left ventricular end-diastolic volume, left ventricular end-systolic volume, left ventricular ejection fraction and the presence of microvascular obstruction and intramyocardial hemorrhage between the two groups in CMR (all P>0.05). At a median follow-up of 31 months, MACCE occurred in 43 (20.4%) patients, and there was no significant difference between the two groups (χ²=3.160，P=0.075). Six cases (2.8%) had all-cause death. The incidence of all-cause death was higher in the group with pleural effusion than that in the group without pleural effusion (9.7% vs. 1.7%, P < 0.05). There was no significant difference in the incidence of other adverse events between the two groups (P>0.05). Multivariate Cox regression analysis showed that advanced age and presence of pleural effusion were independent risk factors of all-cause death during follow-up. Conclusion Patients with AMI combined with pleural effusion have more severe myocardial injury and higher all-cause mortality.

Key words: myocardial infarction, pleural effusion, prognosis, magnetic resonance imaging, echocardiography, Doppler, color, myocardial injury

CLC Number:

R542.22

Figures/Tables 7

References 16

[1]	中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2021概要[J]. 中国循环杂志, 2022, 37(6):553-578.
	The Writing Committee of the Report on Cardiovascular Health and Diseases in China. Report on cardiovascular health and diseases in China 2021:An updated summary[J]. Chinese Circulation Journal, 2022, 37(6):553-578. doi:10.3969/j.issn.1000-3614.2022.06.001.
[2]	JARYAL A, VIKRANT S, SARKAR M, et al. A case report of pleuro-pericardial effusion in a patient on hemodialysis and a cardiac pacemaker[J]. Semin Dial, 2021, 34(4):323-325. doi:10.1111/sdi.12996.
[3]	NISHIMURA M, GODA N, HATAZAWA K, et al. Delayed diagnosis of postcardiac injury syndrome[J]. BMJ Case Rep, 2019, 12(2):e228877. doi:10.1136/bcr-2018-228877.
[4]	殷鑫, 张雨, 邵玥明, 等. 心脏损伤后综合征再发与治疗体会[J]. 天津医药, 2020, 48(6):555-557.
	YIN X, ZHANG Y, SHAO Y M, et al. The clinical experience of recurrence and treatment of post-cardiac injury syndrome[J]. Tianjin Med J, 2020, 48(6):555-557. doi:10.11958/20192963.
[5]	王佳丽, 孔莹, 孙小伶, 等. 磁共振对急性ST段抬高型心肌梗死介入术后左心功能改善的预测价值[J]. 磁共振成像, 2022, 13(2):87-90.
	WANG J L, KONG Y, SUN X L, et al. Predictive value of MRI for cardiac function improvement after intervention in acute myocardial infarction patients[J]. Chin J Magn Reson Imaging, 2022, 13(2):87-90. doi:10.12015/issn.1674-8034.2022.02.018.
[6]	GAO G, FENG L, FU J, et al. Prognostic value of the SYNTAX score on myocardial injury and salvage in STEMI patients after primary percutaneous coronary intervention:A single-center retrospective observational study[J]. BMC Cardiovasc Disord, 2021, 21(1):591. doi:10.1186/s12872-021-02395-7.
[7]	张秀强, 杨涛. 胸腔积液的特点及其鉴别诊断的研究进展[J]. 国际生物医学工程杂志, 2022, 45(6):563-567.
	ZHANG X Q, YANG T. Research progress in the characteristics and differential diagnosis of tuberculous pleural effusion and malignant pleural effusion[J]. International Journal of Biomedical Engineering, 2022, 45(6):563-567. doi:10.3760/cma.j.cn121382-20220715-00617.
[8]	王建林, 王琰华, 史磊. 急性心肌梗死患者LGE-CMR评价结果及其与血清心肌标志物的关系[J]. 天津医药, 2022, 50(4):393-398.
	WANG J L, WANG Y H, SHI L. Relationship between evaluation results of LGE-CMR and serum myocardial markers in patients with acute myocardial infarction[J]. Tianjin Med J, 2022, 50(4):393-398. doi:10.11958/20211980.
[9]	DAVIDSON S J, RONCALLI J, SURDER D, et al. Microvascular obstruction identifies a subgroup of patients who benefit from stem cell therapy following ST-elevation myocardial infarction[J]. Am Heart J, 2023, 259:79-86. doi:10.1016/j.ahj.2023.02.004.
[10]	MASCI P G, PAVON A G, PONTONE G, et al. Early or deferred cardiovascular magnetic resonance after ST-segment-elevation myocardial infarction for effective risk stratification[J]. Eur Heart J Cardiovasc Imaging, 2020, 21(6):632-639. doi:10.1093/ehjci/jez179.
[11]	CALVIERI C, RIVA A, STURLA F, et al. Left ventricular adverse remodeling in ischemic heart disease: emerging cardiac magnetic resonance imaging biomarkers[J]. J Clin Med, 2023, 12(1):334. doi:10.3390/jcm12010334.
[12]	HAMIRANI Y S, WONG A, KRAMER C M, et al. Effect of microvascular obstruction and intramyocardial hemorrhage by CMR on LV remodeling and outcomes after myocardial infarction: a systematic review and meta-analysis[J]. JACC Cardiovasc Imaging, 2014, 7(9):940-952. doi:10.1016/j.jcmg.2014.06.012.
[13]	ØRN S, MANHENKE C, GREVE O J, et al. Microvascular obstruction is a major determinant of infarct healing and subsequent left ventricular remodelling following primary percutaneous coronary intervention[J]. Eur Heart J, 2009, 30(16):1978-1985. doi:10.1093/eurheartj/ehp219.
[14]	ROGUIN A, BEHAR D, BEN AMI H, et al. Long-term prognosis of acute pulmonary oedema--an ominous outcome[J]. Eur J Heart Fail, 2000, 2(2):137-144. doi:10.1016/s1388-9842(00)00069-6.
[15]	HEIDENREICH P A, BOZKURT B, AGUILAR D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: Executive summary:A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[J]. Circulation, 2022, 145(18):e876-e894. doi:10.1161/CIR.0000000000001106.
[16]	中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018[J]. 中华心血管病杂志, 2018, 46(10):760-789.
	Heart Failure Group of Chinese Society of Cardiology of Chinese Medical Association,Chinese Heart Failure Association of Chinese Medical Doctor Association, Editorial Board of Chinese Journal of Cardiology. Chinese guidelines for the diagnosis and treatment of heart failure 2018[J]. Chin J Cardiol, 2018, 46(10):760-789. doi:10.3760/cma.j.issn.0253-3758.2018.10.004.

组别		n		男性		年龄/岁			入院收缩压/mmHg					梗死类型及位置						糖尿病
组别		n		男性		年龄/岁			入院收缩压/mmHg					STEMI-前壁		STEMI-非前壁			NSTEMI	糖尿病
无胸腔积液组		180		135（75.0）		60.29±10.67			136.60±25.06					71（39.4）		89（49.4）			20（11.1）	40（22.2）
有胸腔积液组		31		25（80.6）		61.32±9.64			127.29±36.12					10（32.3）		18（58.1）			3（9.7）	10（32.3）
χ²或t				0.460		0.502			1.568					0.793						1.473
组别			高血压		吸烟			急诊PCI			左主干病变		三支病变		白细胞计数/（×10⁹/L）				肌酸激酶同工酶/（U/L）
无胸腔积液组			86（47.8）		113（62.8）			112（62.2）			12（6.7）		55（30.6）		9.87±3.61				25.0（15.8，54.0）
有胸腔积液组			17（54.8）		18（58.1）			22（71.0）			4（12.9）		11（35.5）		9.74±3.14				20.9（14.0，28.0）
χ²、t或Z			0.528		0.250			0.873			1.468		0.299		0.181				0.923
组别	肌酐清除率/（mL/min）						LDL-C/（mmol/L）			无阿司匹林		无氯吡格雷或替格瑞洛					β受体阻滞剂	ACEI/ARB			他汀类
无胸腔积液组	98.8（75.3，121.1）						2.76±1.11			2（1.1）		8（4.4）					102（56.7）	136（75.6）			167（92.8）
有胸腔积液组	95.7（72.9，114.2）						2.75±1.00			1（3.2）		3（9.7）					19（61.3）	23（74.2）			29（93.5）
χ²、t或Z	0.655						0.075			0.844		1.466					0.231	0.026			0.024

组别		n		男性		年龄/岁			入院收缩压/mmHg					梗死类型及位置						糖尿病
组别		n		男性		年龄/岁			入院收缩压/mmHg					STEMI-前壁		STEMI-非前壁			NSTEMI	糖尿病
无胸腔积液组		180		135（75.0）		60.29±10.67			136.60±25.06					71（39.4）		89（49.4）			20（11.1）	40（22.2）
有胸腔积液组		31		25（80.6）		61.32±9.64			127.29±36.12					10（32.3）		18（58.1）			3（9.7）	10（32.3）
χ²或t				0.460		0.502			1.568					0.793						1.473
组别			高血压		吸烟			急诊PCI			左主干病变		三支病变		白细胞计数/（×10⁹/L）				肌酸激酶同工酶/（U/L）
无胸腔积液组			86（47.8）		113（62.8）			112（62.2）			12（6.7）		55（30.6）		9.87±3.61				25.0（15.8，54.0）
有胸腔积液组			17（54.8）		18（58.1）			22（71.0）			4（12.9）		11（35.5）		9.74±3.14				20.9（14.0，28.0）
χ²、t或Z			0.528		0.250			0.873			1.468		0.299		0.181				0.923
组别	肌酐清除率/（mL/min）						LDL-C/（mmol/L）			无阿司匹林		无氯吡格雷或替格瑞洛					β受体阻滞剂	ACEI/ARB			他汀类
无胸腔积液组	98.8（75.3，121.1）						2.76±1.11			2（1.1）		8（4.4）					102（56.7）	136（75.6）			167（92.8）
有胸腔积液组	95.7（72.9，114.2）						2.75±1.00			1（3.2）		3（9.7）					19（61.3）	23（74.2）			29（93.5）
χ²、t或Z	0.655						0.075			0.844		1.466					0.231	0.026			0.024

组别	n	IS/（%LV）	MVO	IMH	LVEDV/mL	LVESV/mL	LVEF
无胸腔积液组	180	33.53±12.74	60（33.3）	34（18.9）	125.77±45.86	63.73±38.20	0.51±0.12
有胸腔积液组	31	35.85±11.83	16（51.6）	10（32.3）	130.93±40.83	71.18±34.99	0.47±0.14
χ²或t		0.945	3.834	2.864	0.587	1.015	1.720

组别	n	IS/（%LV）	MVO	IMH	LVEDV/mL	LVESV/mL	LVEF
无胸腔积液组	180	33.53±12.74	60（33.3）	34（18.9）	125.77±45.86	63.73±38.20	0.51±0.12
有胸腔积液组	31	35.85±11.83	16（51.6）	10（32.3）	130.93±40.83	71.18±34.99	0.47±0.14
χ²或t		0.945	3.834	2.864	0.587	1.015	1.720

组别	n	LAD/mm	LVEDD/mm	LVEF
无胸腔积液组	180	37.59±4.94	48.33±7.02	0.58±0.09
有胸腔积液组	31	38.67±4.90	51.12±6.15	0.54±0.09
t		1.109	2.081^＊	2.267^＊