经胸多普勒超声心动图对冠状动脉血流储备的早期评估可预测再灌注性前壁心肌梗死的晚期重构。

Early assessment of coronary flow reserve by transthoracic Doppler echocardiography predicts late remodeling in reperfused anterior myocardial infarction.

作者信息

Rigo Fausto, Varga Zsuzsanna, Di Pede Francesco, Grassi Giuseppe, Turiano Giovanni, Zuin Guerrino, Coli Ugo, Raviele Antonio, Picano Eugenio

机构信息

Cardiology Department, Umberto I Hospital, Institute of Clinical Physiology, Pisa, Italy.

出版信息

J Am Soc Echocardiogr. 2004 Jul;17(7):750-5. doi: 10.1016/j.echo.2004.04.023.

DOI:10.1016/j.echo.2004.04.023

PMID:15220900

Abstract

BACKGROUND

Microvascular integrity is an essential determinant of favorable late outcome in reperfused myocardial infarction. Coronary flow reserve (CFR) can be assessed by transthoracic Doppler echocardiography and provides a functional estimate of microvascular integrity downstream from the patent infarct-related vessel.

OBJECTIVE

We sought to assess the effects of CFR in predicting late left ventricular (LV) remodeling in patients with reperfused acute anterior myocardial infarction treated with primary angioplasty.

METHODS

In all, 31 patients admitted with acute anterior myocardial infarction underwent primary angioplasty of the infarct-related vessel. After angioplasty, angiographic thrombosis in myocardial infarction (TIMI) grade and myocardial blush were scored. On the first day, all underwent stress echocardiography and CFR evaluation of left anterior descending coronary artery by transthoracic Doppler. All patients had resting 2-dimensional echocardiography at 1, 3, and 6 months for assessment of LV function.

RESULTS

CFR could be successfully assessed in 31 patients. After 6 months 5 patients showed LV dilatation (group I), whereas 26 patients did not show significant variation (group II). On day 1, CFR was higher (group I = 1.43 +/- 0.11 vs group II = 1.67 +/- 0.26, P =.005) and the deceleration time of diastolic left anterior descending coronary artery flow velocity was longer (group I = 212 +/- 41.4 milliseconds vs group II = 286 +/- 106.7 milliseconds, P <.02) in patients without, compared with those with LV remodeling, whereas there was no difference in angiographic parameters.

CONCLUSION

Early assessment of CFR and the pattern of baseline diastolic coronary flow velocity by transthoracic Doppler echocardiography is feasible, safe, and more useful than angiographic indices in identifying patients at high risk of remodeling in spite of successful primary angioplasty.

摘要

背景

微血管完整性是再灌注心肌梗死良好远期预后的重要决定因素。冠状动脉血流储备（CFR）可通过经胸多普勒超声心动图进行评估，并能对梗死相关血管通畅下游的微血管完整性进行功能评估。

目的

我们旨在评估CFR对接受直接经皮冠状动脉腔内血管成形术（PTCA）治疗的再灌注急性前壁心肌梗死患者左心室（LV）晚期重构的预测作用。

方法

总共31例急性前壁心肌梗死患者接受了梗死相关血管的直接PTCA。血管成形术后，对心肌梗死溶栓试验（TIMI）分级和心肌造影剂增强进行血管造影评分。第一天，所有患者均接受了负荷超声心动图检查，并通过经胸多普勒对左前降支冠状动脉进行CFR评估。所有患者在1、3和6个月时均进行静息二维超声心动图检查以评估左心室功能。

结果

31例患者的CFR均成功评估。6个月后，5例患者出现左心室扩张（I组），而26例患者未出现明显变化（II组）。第一天，与发生左心室重构的患者相比，未发生左心室重构的患者CFR较高（I组=1.43±0.11 vs II组=1.67±0.26，P=0.005），舒张期左前降支冠状动脉血流速度的减速时间更长（I组=212±41.4毫秒vs II组=286±106.7毫秒，P<0.02），而血管造影参数无差异。