Bolognese Leonardo, Carrabba Nazario, Parodi Guido, Santoro Giovanni M, Buonamici Piergiovanni, Cerisano Giampaolo, Antoniucci David
Division of Cardiology, S. Donato Hospital, Arezzo, Italy.
Circulation. 2004 Mar 9;109(9):1121-6. doi: 10.1161/01.CIR.0000118496.44135.A7. Epub 2004 Feb 16.
We hypothesized that preserved microvascular integrity in the area at risk would favorably influence left ventricular (LV) remodeling and long-term outcome after acute myocardial infarction.
Before and after successful primary angioplasty (percutaneous transluminal coronary angioplasty [PTCA]), 124 patients with acute myocardial infarction underwent intracoronary myocardial contrast echo (MCE). An MCE score index (MCESI) was derived by averaging the single-segment score (0=not visible, 1=patchy, 2=homogeneous contrast effect) within the area at risk. An MCESI > or =1 was considered adequate reperfusion. Mean follow-up was 46+/-32 months. After PTCA, 100 patients showed adequate reperfusion (no microvascular dysfunction, NoMD), whereas 24 did not (MD). MD patients had a higher mean creatine kinase (4153+/-2422 versus 2743+/-1774 U/L; P=0.002) and baseline wall-motion score index (2.61+/-0.31 versus 2.25+/-0.42; P<0.001) and a lower baseline ejection fraction (33+/-8% versus 40+/-7%; P<0.001). From day 1 on, LV volumes progressively increased in the MD patients (n=19) and were larger than those of NoMD patients (n=85) at 6 months (end-diastolic volume 170+/-55 versus 115+/-29 mL; P<0.001). MCESI was the most important independent predictor of LV dilation (OR 0.61, 95% CI 0.52 to 0.71, P<0.000001). By Cox analysis, MD represented the only predictor of cardiac death (OR 0.26, 95% CI 0.09 to 0.72, P=0.010) and combined events (cardiac death, reinfarction, and heart failure; OR 0.44, 95% CI 0.23 to 0.85, P=0.014). MD patients showed worse survival in terms of cardiac death (P<0.0001) and combined events (P<0.0001).
In reperfused acute myocardial infarction, MD within the risk area is an important predictor of both LV remodeling and unfavorable long-term outcome.
我们推测，梗死相关区域微血管完整性的保留对急性心肌梗死后左心室（LV）重构和长期预后具有积极影响。
124例急性心肌梗死患者在成功进行直接血管成形术（经皮腔内冠状动脉血管成形术[PTCA]）前后接受了冠状动脉内心肌对比超声心动图（MCE）检查。通过对梗死相关区域单节段评分（0=不可见，1=片状，2=均匀对比增强）进行平均得出MCE评分指数（MCESI）。MCESI≥1被认为是再灌注充分。平均随访时间为46±32个月。PTCA术后，100例患者显示再灌注充分（无微血管功能障碍，NoMD），而24例患者则未达到充分再灌注（MD）。MD患者的平均肌酸激酶水平更高（4153±2422 vs 2743±1774 U/L；P=0.002），基线壁运动评分指数更高（2.61±0.31 vs 2.25±0.42；P<0.001），而基线射血分数更低（33±8% vs 40±7%；P<0.001）。从第1天起，MD患者（n=19）的左心室容积逐渐增加，在6个月时大于NoMD患者（n=85）（舒张末期容积170±55 vs 115±29 mL；P<0.001）。MCESI是左心室扩张最重要的独立预测因素（OR 0.61，95%CI 0.52至0.71，P<0.000001）。通过Cox分析，MD是心源性死亡（OR 0.26，95%CI 0.09至0.72，P=0.010）和复合事件（心源性死亡、再梗死和心力衰竭；OR 0.44，95%CI 0.23至0.85，P=0.014）的唯一预测因素。在心脏死亡（P<0.0001）和复合事件（P<0.0001）方面，MD患者的生存率更差。
在再灌注的急性心肌梗死中，梗死相关区域的MD是左心室重构和不良长期预后重要的预测因素。
