急性心肌梗死合并梗死前心绞痛患者微血管及心肌损伤减轻。

Reduced microvascular and myocardial damage in patients with acute myocardial infarction and preinfarction angina.

作者信息

Colonna Paolo, Cadeddu Christian, Montisci Roberta, Ruscazio Massimo, Selem Abdel Hakem, Chen Lijun, Onnis Enrico, Meloni Luigi, Iliceto Sabino

机构信息

Department of Cardiovascular and Neurological Sciences, University of Cagliari, Cagliari, Italy.

出版信息

Am Heart J. 2002 Nov;144(5):796-803. doi: 10.1067/mhj.2002.123835.

DOI:10.1067/mhj.2002.123835

PMID:12422147

Abstract

BACKGROUND

After acute myocardial infarction, the presence of ischemic preconditioning as a result of preinfarction angina has a protective role, limiting necrosis extent and guaranteeing greater myocardial functional recovery. The relationship between preinfarction angina, microvascular reflow, and myocardial function is poorly known. We hypothesized that after acute myocardial infarction patients with preinfarction angina have both microvascular integrity and myocardial function preservation.

METHODS AND RESULTS

In 51 patients with a first acute myocardial infarction, we noninvasively assessed microvascular perfusion and coronary flow reserve with intravenous myocardial contrast echocardiography and investigated myocardial contractile recovery with low-dose dobutamine and 90-day follow-up echocardiography. Typical angina was present in 25 patients and absent in 26 patients during the 7 days preceding the myocardial infarction. Compared with those patients without preinfarction angina, patients with preinfarction angina showed a greater microvascular reflow extent and coronary flow reserve (respectively, 25.2% +/- 22.8% vs 48.3% +/- 23.3%, P <.05, and 3.44 +/- 0.75 vs 1.95 +/- 0.67, P <.0001), a better regional myocardial function, as expressed with wall motion score index in the risk area at dobutamine (1.67 +/- 0.61 vs 2.10 +/- 0.43, P <.005) and at follow-up (1.72 +/- 0.56 vs 2.22 +/- 0.40, P <.0001) echocardiogram, despite being similar in the first echocardiogram (2.60 +/- 0.28 vs 2.63 +/- 0.28, P = not significant), and significantly less pronounced left ventricular dilation at follow-up.

CONCLUSION

Presence of preinfarction angina, because of the preconditioning effect, reduces myocardial damage and favors myocardial viability, limiting left ventricular remodeling. This beneficial effect seems to be at least partly mediated by the more preserved microvascular integrity and functional vasodilation after acute myocardial infarction.

摘要

背景

急性心肌梗死后，梗死前心绞痛所致的缺血预处理具有保护作用，可限制坏死范围并保证更好的心肌功能恢复。梗死前心绞痛、微血管再灌注与心肌功能之间的关系尚不清楚。我们推测，急性心肌梗死后，有梗死前心绞痛的患者微血管完整性和心肌功能均得以保留。

方法与结果

在51例首次发生急性心肌梗死的患者中，我们通过静脉心肌对比超声心动图对微血管灌注和冠状动脉血流储备进行了无创评估，并通过小剂量多巴酚丁胺及90天随访超声心动图研究了心肌收缩功能的恢复情况。在心肌梗死前7天内，25例患者出现典型心绞痛，26例患者未出现。与无梗死前心绞痛的患者相比，有梗死前心绞痛的患者微血管再灌注范围更大，冠状动脉血流储备更高（分别为25.2%±22.8% 对48.3%±23.3%，P<.05；3.44±0.75对1.95±0.67，P<.0001），区域心肌功能更好，多巴酚丁胺负荷试验时危险区域的室壁运动评分指数（1.67±0.61对2.10±0.43，P<.005）及随访时（1.72±0.56对2.22±0.40，P<.0001）均如此，尽管首次超声心动图检查时二者相似（2.60±0.28对2.63±0.2,8，P=无显著差异），且随访时左心室扩张程度明显较轻。