Swinburn J M, Lahiri A, Senior R
Department of Cardiac Research, Northwick Park Hospital, Harrow, United Kingdom.
J Am Coll Cardiol. 2001 Jul;38(1):19-25. doi: 10.1016/s0735-1097(01)01317-1.
We aimed to ascertain whether triggered intravenous myocardial contrast echocardiography (MCE) can predict functional recovery in patients with acute myocardial infarction (AMI) and to determine the optimal triggering interval in this setting.
Detection of myocardial viability early after AMI has both therapeutic and prognostic implications. Myocardial contrast echocardiography using intracoronary injections of contrast can detect viable myocardium, but there is little data on the use of recently developed intravenous MCE techniques for this purpose.
Ninety-six patients with recent AMI (4.8 +/- 1.7 days) underwent echocardiography at baseline and six months later or three months after revascularization to determine regional function (score 1 = normal to 3 = akinetic). Myocardial contrast echocardiography was performed at baseline using intravenous injections of Optison. Triggering intervals of 1:1 (early) and 1:10 (delayed) cardiac cycles were used. Segments were deemed viable if they demonstrated homogeneous contrast opacification.
Of 400 akinetic segments at baseline, 109 (27%) improved during the follow-up period, and 375 (94%) were adequately visualized with MCE, of which 59 (16%) were homogeneously opacified by early and 125 (33%) by delayed MCE (negative predictive value for recovery of contractile function 74% and 84%, positive predictive value 29% and 47%, respectively). Independent predictors of functional recovery were delayed MCE (odds ratio [OR]: 4.0, p < 0.001), revascularization (OR: 6.0, p < 0.001), and log creatine kinase (OR: 0.5, p = 0.03). However, the presence or absence of >90% stenosis of the infarct-related artery did not influence the ability of triggered MCE to predict functional recovery.
Intravenous delayed triggered MCE can independently detect myocardial viability early after AMI.
我们旨在确定触发式静脉心肌对比超声心动图（MCE）能否预测急性心肌梗死（AMI）患者的功能恢复情况，并确定在此情况下的最佳触发间隔。
AMI后早期检测心肌存活情况具有治疗和预后意义。使用冠状动脉内注射造影剂的心肌对比超声心动图可检测存活心肌，但关于为此目的使用最近开发的静脉MCE技术的数据很少。
96例近期AMI患者（4.8±1.7天）在基线时以及6个月后或血运重建后3个月接受超声心动图检查，以确定局部功能（评分1 =正常至3 =运动不能）。在基线时使用静脉注射Optison进行心肌对比超声心动图检查。使用1:1（早期）和1:10（延迟）心动周期的触发间隔。如果节段显示均匀的造影剂充盈，则认为其存活。
在基线时的400个运动不能节段中，109个（27%）在随访期间有所改善，375个（94%）通过MCE得到充分显影，其中59个（16%）通过早期MCE均匀充盈，125个（33%）通过延迟MCE均匀充盈（收缩功能恢复的阴性预测值分别为74%和84%，阳性预测值分别为29%和47%）。功能恢复的独立预测因素为延迟MCE（比值比[OR]：4.0，p<0.001）、血运重建（OR：6.0，p<0.001）和肌酸激酶对数（OR：0.5，p = 0.03）。然而，梗死相关动脉是否存在>90%的狭窄并不影响触发式MCE预测功能恢复的能力。
静脉延迟触发式MCE可在AMI后早期独立检测心肌存活情况。
