Klisiewicz Anna, Michałek Piotr, Szymański Piotr, Hoffman Piotr
Department of Non-Invasive Cardiology, National Institute of Cardiology, Warsaw, Poland.
Clin Cardiol. 2003 Nov;26(11):503-7. doi: 10.1002/clc.4960261105.
Angioplasty of an infarct related artery (IRA) performed several weeks or months after myocardial infarction (MI) may improve myocardial function.
We hypothesized that, as Doppler myocardial imaging (DMI) allows for the quantitative assessment of the systolic movement of myocardial segments, it may be a sensitive method for assessing changes in regional myocardial contraction and contractile reserve pre and post angioplasty of the IRA.
In all, 39 patients (30 men, mean age 53.4 +/- 8.3 years), 1 to 6 months after MI, who qualified for IRA angioplasty on the basis of myocardial viability in the infarcted zone as demonstrated by dobutamine stress echocardiography, were included in the study. Peak regional myocardial systolic velocities (S wave) of the infarcted segments were measured at rest and during low-dose dobutamine infusion (15 microg/kg/min) 1 day before angioplasty (Exam 1), 2 to 5 days (Exam 2), and 30 days (Exam 3) after successful angioplasty. The long-axis movement of the mitral annulus and of the basal and medial segments of the posterior (20 patients), anterior (17 patients), and lateral walls (2 patients) was evaluated.
At rest, S-wave velocity of the infarcted segments increased between Exams 1 and 2, without further improvement between Exams 2 and 3 (4.9 +/- 1.2 vs. 5.6 +/- 1.3 cm/s, p < 0.05 and 5.6 +/- 1.3 vs. 5.5 +/- 1.3 cm/s, NS, respectively). However, S-wave velocities measured during low-dose dobutamine infusion differed significantly both between Exams 1 and 2, and 2 and 3 (7.0 +/- 1.5 vs. 7.8 +/- 1.8 cm/s; p < 0.01; 7.8 +/- 1.8 vs. 8.5 +/- 1.6 cm/s; p < 0.05).
Resting contractility at an infarct zone demonstrated rapid initial improvement after angioplasty of the IRA with no further change, whereas contractile reserve improved not only immediately after angioplasty but also during the next month.
心肌梗死（MI）几周或几个月后对梗死相关动脉（IRA）进行血管成形术可能改善心肌功能。
我们假设，由于多普勒心肌成像（DMI）可对心肌节段的收缩运动进行定量评估，它可能是评估IRA血管成形术前后局部心肌收缩及收缩储备变化的一种敏感方法。
共有39例患者（30例男性，平均年龄53.4±8.3岁），在MI后1至6个月，基于多巴酚丁胺负荷超声心动图显示梗死区域心肌存活情况而符合IRA血管成形术条件，被纳入研究。在血管成形术前1天（检查1）、成功血管成形术后2至5天（检查2）和30天（检查3），测量梗死节段的局部心肌收缩期峰值速度（S波），测量静息状态下以及低剂量多巴酚丁胺输注（15μg/kg/min）期间的该速度。评估二尖瓣环以及后侧壁（20例患者）、前侧壁（17例患者）和侧壁（2例患者）的基底段和中间段的长轴运动。
静息状态下，梗死节段的S波速度在检查1和检查2之间增加，在检查2和检查3之间无进一步改善（分别为4.9±1.2 vs. 5.6±1.3 cm/s，p<0.05；5.6±1.3 vs. 5.5±1.3 cm/s，无显著性差异）。然而，在低剂量多巴酚丁胺输注期间测量的S波速度在检查1和检查2之间以及检查2和检查3之间均有显著差异（7.0±1.5 vs. 7.8±1.8 cm/s；p<0.01；7.8±1.8 vs. 8.5±1.6 cm/s；p<0.05）。
IRA血管成形术后梗死区域的静息收缩力最初迅速改善且无进一步变化，而收缩储备不仅在血管成形术后立即改善，而且在接下来的一个月内也有所改善。
