Andrássy P, Zielinska M, Busch R, Schömig A, Firschke C
Deutsches Herzzentrum München, Lazarettstrasse 36, D-80636 Munich, Germany.
Heart. 2002 Apr;87(4):350-5. doi: 10.1136/heart.87.4.350.
Myocardial capillary perfusion is a prerequisite of myocellular viability after reperfusion of acute myocardial infarction. It was hypothesised that the magnitude of myocardial capillary perfusion, assessed by transmural signal intensity in venous contrast echocardiography as a corollary of the blood volume of myocardial capillaries, and the amount of viable myocardium, represented by differential levels of contractile function two weeks after reperfusion, are correlated.
To evaluate the role of venous contrast echocardiography for the identification of viable myocardium in patients with acute myocardial infarction early after successful mechanical reperfusion.
60 patients with a first acute myocardial infarction underwent venous contrast echocardiography several hours after successful mechanical reperfusion (median time interval 190 min.). The relative transmural videointensity (median (25th, 75th percentiles)) of akinetic segments was determined. After two weeks, contractile function was re-evaluated at rest and during dobutamine infusion if segments without functional recovery were present.
Relative videointensity early after reperfusion differed significantly between functional groups after two weeks: normokinesia (88% (77%, 100%)), hypokinesia (74% (54%, 99%)), and akinesia with (61% (48%, 76%)) and without contractile reserve (31% (22%, 46%)). Relative videointensity and contractile function were significantly correlated (r = -0.67). The diagnostic accuracy of relative videointensity > 50% for prediction of contractility of initially akinetic segments at rest or during dobutamine was 82% (chi2 = 76.2, p < 0.001).
Early after successful mechanical reperfusion of acute myocardial infarction, the magnitude of capillary perfusion in the perfusion territory of an infarct related artery is correlated with the amount of viable myocardium. Quantitative venous contrast echocardiography can be used for accurate identification of viable myocardium.
心肌毛细血管灌注是急性心肌梗死再灌注后心肌细胞存活的前提条件。有假设认为，通过静脉对比超声心动图中跨壁信号强度评估的心肌毛细血管灌注量（作为心肌毛细血管血容量的一个推论）与再灌注两周后以收缩功能差异水平表示的存活心肌量相关。
评估静脉对比超声心动图在成功进行机械再灌注后早期对急性心肌梗死患者存活心肌识别中的作用。
60例首次发生急性心肌梗死的患者在成功进行机械再灌注数小时后（中位时间间隔190分钟）接受静脉对比超声心动图检查。测定运动减弱节段的相对跨壁视频强度（中位数（第25、75百分位数））。两周后，如果存在无功能恢复的节段，则在静息状态和多巴酚丁胺输注期间重新评估收缩功能。
再灌注后早期，两周后的功能组之间相对视频强度有显著差异：运动正常（88%（77%，100%））、运动减弱（74%（54%，99%））、有收缩储备的运动消失（61%（48%，76%））和无收缩储备的运动消失（31%（22%，46%））。相对视频强度与收缩功能显著相关（r = -0.67）。相对视频强度>50%预测最初运动消失节段静息或多巴酚丁胺输注期间收缩性的诊断准确性为82%（χ2 = 76.2，p < 0.001）。
在急性心肌梗死成功进行机械再灌注后早期，梗死相关动脉灌注区域的毛细血管灌注量与存活心肌量相关。定量静脉对比超声心动图可用于准确识别存活心肌。
