Bigi R, Curti G, Sponzilli C, Castini D, Occhi G, Fiorentini C
Division of Cardiology, E. Morelli Hospital, Sondalo, Italy.
Int J Card Imaging. 1998 Dec;14(6):381-4. doi: 10.1023/a:1006028526024.
Stress-induced asynergies in the infarct area following thrombolytic therapy are considered to reflect incomplete recanalization of the culprit vessel. However, reperfusion is a dynamic process with successive pathophysiological phases, so that the timing of assessment of residual ischemia may have relevant clinical implications. We studied the time-course of dobutamine-induced homozonal asynergies in 61 (group B) survivors of uncomplicated infarction as compared to 54 (group A) control subjects showing normal response to dobutamine stress echocardiography within 10 days of acute myocardial infarction. The 79 (43 of group A and 36 of group B) patients not presenting new cardiac events underwent further dobutamine stress echo within 90 +/- 17 days, which was positive in 20 and negative in 59. Persistence of test positivity was observed in just 17/36 (47%) patients, who showed significantly more extensive dobutamine-induced asynergies as compared to pre-discharge evaluation and less frequent (p < 0.01) evidence of viable myocardium. These results arise question about the decisional impact of stress-induced wall motion abnormalities in the culprit vessel area early after thrombolysis in low-risk patients and emphasize the need to further clarify the time factor role in this setting.
溶栓治疗后梗死区域出现的应激诱导性协同失调被认为反映了罪犯血管再通不完全。然而，再灌注是一个具有连续病理生理阶段的动态过程，因此评估残余缺血的时间可能具有相关的临床意义。我们研究了61例（B组）无并发症梗死幸存者中多巴酚丁胺诱导的同区域协同失调的时间进程，并与54例（A组）对照受试者进行比较，这些对照受试者在急性心肌梗死10天内对多巴酚丁胺负荷超声心动图显示正常反应。79例（A组43例，B组36例）未出现新的心脏事件的患者在90±17天内接受了进一步的多巴酚丁胺负荷超声心动图检查，其中20例为阳性，59例为阴性。仅17/36（47%）的患者观察到检查阳性持续存在，与出院前评估相比，这些患者多巴酚丁胺诱导的协同失调明显更广泛，存活心肌的证据更少（p<0.01）。这些结果引发了关于低风险患者溶栓后早期罪犯血管区域应激诱导的壁运动异常的决策影响的问题，并强调需要进一步阐明这种情况下时间因素的作用。
