Michaels A D, Gibson C M, Barron H V
Department of Medicine, University of California at San Francisco Medical Center, 94143-0124, USA.
Am J Cardiol. 2000 Mar 9;85(5A):50B-60B. doi: 10.1016/s0002-9149(00)00811-0.
Recent interest has shifted from infarct artery patency to microvascular perfusion in the evaluation of patients with acute myocardial infarction (AMI). Microvascular dysfunction occurs in a substantial proportion of patients, despite aggressive therapy with thrombolytic agents and/or percutaneous mechanical revascularization techniques. Patients with impaired microvascular perfusion after immediate reperfusion therapy have an adverse clinical prognosis. Recent studies have extended our understanding of the pathophysiology of this so-called no-reflow phenomenon, focusing on the critical roles of platelet and inflammatory mediators leading to microvascular obstruction and reperfusion injury. Moving beyond the Thrombolysis in Myocardial Infarction (TIMI) flow grade system, new techniques have been developed to assess microvascular perfusion, including TIMI frame counting, angiographic myocardial perfusion grading, myocardial contrast echocardiography, Doppler flow wire studies, nuclear scintigraphy, and magnetic resonance imaging. Armed with a greater understanding of the primary mediators of microvascular dysfunction, these tools may identify improved therapy directed at optimizing myocardial perfusion in patients with AMI.
在急性心肌梗死（AMI）患者的评估中，近期关注点已从梗死动脉通畅性转移至微血管灌注。尽管采用溶栓药物和/或经皮机械血管重建技术进行积极治疗，但仍有相当一部分患者发生微血管功能障碍。即刻再灌注治疗后微血管灌注受损的患者临床预后不良。近期研究拓展了我们对这种所谓无复流现象病理生理学的认识，重点关注血小板和炎症介质在导致微血管阻塞和再灌注损伤中的关键作用。除了心肌梗死溶栓治疗（TIMI）血流分级系统外，已开发出新技术来评估微血管灌注，包括TIMI帧数计数、血管造影心肌灌注分级、心肌对比超声心动图、多普勒血流导丝研究、核素显像和磁共振成像。基于对微血管功能障碍主要介质的更深入了解，这些工具可能识别出针对优化AMI患者心肌灌注的改进治疗方法。
