冠状动脉再灌注后短期随访期间的冠状动脉血流速度分析：经胸多普勒超声心动图用于预测急性心肌梗死患者局部室壁运动恢复情况
Coronary flow velocity analysis during short term follow up after coronary reperfusion: use of transthoracic Doppler echocardiography to predict regional wall motion recovery in patients with acute myocardial infarction.
作者信息
Hozumi T, Kanzaki Y, Ueda Y, Yamamuro A, Takagi T, Akasaka T, Homma S, Yoshida K, Yoshikawa J
机构信息
Department of Internal Medicine and Cardiology, Osaka City University School of Medicine, Osaka, Japan.
出版信息
Heart. 2003 Oct;89(10):1163-8. doi: 10.1136/heart.89.10.1163.
BACKGROUND
A recent study using a Doppler guide wire showed that coronary flow velocity measurements immediately after coronary reperfusion were useful in predicting recovery of regional left ventricular function. The value of coronary flow velocity analyses during follow up after reperfusion has not been established in the clinical setting.
OBJECTIVE
To evaluate coronary flow velocity measurements in predicting recovery of regional left ventricular function during short term follow up after acute anterior myocardial infarction, using transthoracic Doppler echocardiography (TTDE).
METHODS
30 consecutive patients with anterior acute myocardial infarction were studied. They all underwent successful coronary angioplasty for lesions in the left anterior descending coronary artery (LAD). Using TTDE, coronary flow velocity in the LAD was recorded on days 1 and 3, and at one and two weeks after reperfusion. Regional wall motion was analysed by the wall motion score index (WMSI), calculated as an average of segmental scores in the LAD territory before reperfusion and one month after the infarction.
RESULTS
Deceleration time of diastolic flow velocity (DDT) in patients with viable myocardium (WMSI in LAD territory at one month, < 2.0) was significantly longer after recanalisation than in patients without viable myocardium (WMSI in LAD territory at one month, > 2.0): 657 (226) v 271 (117) ms on day 1, p < 0.001; 732 (219) v 373 (217) ms on day 3, p < 0.01; and 903 (107) v 577 (300) ms at one week, p < 0.01. However, the difference at two weeks (991 (75) v 795 (281) ms) was not significant. For the prediction of viable myocardium, DDT > 600 ms had a sensitivity of 78% and a specificity of 92% on day 1, and a sensitivity of 78% and a specificity of 84% on day 3. At one and two weeks, DDT > 600 ms was sensitive (100% and 100%, respectively) but less specific (46% and 26%, respectively) for predicting viable myocardium.
CONCLUSIONS
Non-invasive assessment of coronary flow velocity using TTDE within three days of successful coronary angioplasty in patients with anterior acute myocardial infarction is useful in predicting recovery of regional left ventricular function.
背景
最近一项使用多普勒导丝的研究表明，冠状动脉再灌注后立即进行冠状动脉血流速度测量有助于预测左心室局部功能的恢复。在临床环境中，再灌注后随访期间冠状动脉血流速度分析的价值尚未确定。
目的
使用经胸多普勒超声心动图（TTDE）评估急性前壁心肌梗死后短期随访期间冠状动脉血流速度测量对左心室局部功能恢复的预测价值。
方法
对30例连续的前壁急性心肌梗死患者进行研究。他们均接受了针对左前降支冠状动脉（LAD）病变的成功冠状动脉血管成形术。使用TTDE，在再灌注后第1天和第3天以及1周和2周记录LAD中的冠状动脉血流速度。通过壁运动评分指数（WMSI）分析局部壁运动，该指数计算为再灌注前和梗死后1个月LAD区域节段评分的平均值。
结果
存活心肌患者（1个月时LAD区域WMSI<2.0）舒张期血流速度减速时间（DDT）再通后明显长于无存活心肌患者（1个月时LAD区域WMSI>2.0）：第1天为657（226）对271（117）毫秒，p<0.001；第3天为732（219）对373（217）毫秒，p<0.01；1周时为903（107）对577（300）毫秒，p<0.01。然而，2周时的差异（991（75）对795（281）毫秒）不显著。对于存活心肌的预测，DDT>600毫秒在第1天的敏感性为78%，特异性为92%，在第3天的敏感性为78%，特异性为84%。在1周和2周时，DDT>600毫秒对存活心肌的预测敏感（分别为100%和100%）但特异性较低（分别为46%和26%）。
结论
对于前壁急性心肌梗死患者，在成功冠状动脉血管成形术三天内使用TTDE对冠状动脉血流速度进行无创评估有助于预测左心室局部功能的恢复。
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