溶栓成功后即刻出现心肌灌注缺乏。前壁心肌梗死左心室功能恢复不良的一个预测指标。

Lack of myocardial perfusion immediately after successful thrombolysis. A predictor of poor recovery of left ventricular function in anterior myocardial infarction.

作者信息

Ito H, Tomooka T, Sakai N, Yu H, Higashino Y, Fujii K, Masuyama T, Kitabatake A, Minamino T

机构信息

Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan.

出版信息

Circulation. 1992 May;85(5):1699-705. doi: 10.1161/01.cir.85.5.1699.

DOI:10.1161/01.cir.85.5.1699

PMID:1572028

Abstract

BACKGROUND

We investigated myocardial perfusion dynamics after thrombolysis and its clinical implications.

METHODS AND RESULTS

We studied 39 patients with acute anterior myocardial infarction (AMI). Myocardial contrast echocardiography (MCE) was performed before and immediately after successful reflow with intracoronary injection of sonicated Ioxaglate. The average segmental score by two-dimensional echocardiography (graded 0, normal, to 3, akinetic/dyskinetic) and global ejection fraction (left ventricular ejection fraction, LVEF%) by left ventriculography were measured at 1 day and at 4 weeks after reflow. Hypokinesis in the infarct region was assessed by the centerline method and expressed in terms of standard deviations (regional wall motion [RWM]: SD/chord) of normal. Immediately after reflow, 30 of 39 patients (group A) showed significant contrast enhancement within the risk area. The other nine patients (23%, group B), however, showed the residual contrast defect in the risk area (myocardial no reflow). There were no significant differences in the elapsed time, angiographic collateral grade, and degree of residual stenosis between group A and group B. Before reflow, both groups exhibited similar levels of global and regional left ventricular function. Improvement in global (LVEF, average segmental score) and regional left ventricular function was greater in group A than in group B (average segmental score, 0.44 +/- 0.41 versus 0.97 +/- 0.36, p less than 0.01; LVEF, 56.4 +/- 13.4 versus 42.7 +/- 8.9, p less than 0.05; RWM, -1.87 +/- 0.85 versus -3.18 +/- 0.52, p less than 0.005).

CONCLUSIONS

MCE demonstrates that angiographically successful reflow cannot be used as an indicator of successful myocardial reperfusion in AMI patients. The residual contrast defect in the risk area demonstrated immediately after reflow is a predictor of poor functional recovery of the postischemic myocardium.

摘要

背景

我们研究了溶栓后心肌灌注动力学及其临床意义。

方法与结果

我们研究了39例急性前壁心肌梗死（AMI）患者。在冠状动脉内注射超声乳化碘克沙醇成功再灌注前及再灌注后即刻进行心肌对比超声心动图（MCE）检查。在再灌注后1天和4周时，通过二维超声心动图测量平均节段评分（分级为0，正常，至3，运动减弱/运动障碍），并通过左心室造影测量整体射血分数（左心室射血分数，LVEF%）。梗死区域的运动减弱通过中心线法评估，并以正常标准差（区域壁运动[RWM]：标准差/弦）表示。再灌注后即刻，39例患者中的30例（A组）在危险区域显示出明显的对比增强。然而，其他9例患者（23%，B组）在危险区域显示出残留的对比缺损（心肌无再灌注）。A组和B组在经过时间、血管造影侧支分级和残留狭窄程度方面无显著差异。再灌注前，两组的整体和区域左心室功能水平相似。A组的整体（LVEF、平均节段评分）和区域左心室功能改善大于B组（平均节段评分，0.44±0.41对0.97±0.36，p<0.01；LVEF，56.4±13.4对42.7±8.9，p<0.05；RWM，-1.87±0.85对-3.18±0.52，p<0.005）。