Araszkiewicz Aleksander, Lesiak Maciej, Grajek Stefan, Prech Marek, Cieśliński Andrzej
I Department of Cardiology, University of Medical Sciences, ul. Długa 1/2, 61-848 Poznań, Poland.
Kardiol Pol. 2006 Apr;64(4):383-8; discussion 389-90.
Pathological left ventricular remodelling is considered the main cause of heart failure in patients after myocardial infarction.
The purpose of this study was to evaluate correlations between the degree of coronary microvascular reperfusion assessed by means of the angiographic myocardial blush grade (MBG) scale and adverse left ventricular remodelling in patients with acute myocardial infarction treated with primary coronary angioplasty.
This study involved 92 consecutive patients, hospitalised because of their first anterior wall myocardial infarction, who underwent successful (TIMI-3 grade flow) primary coronary angioplasty. Angiographic myocardial reperfusion parameters (MBG, corrected TIMI Frame Count) were assessed. Three days and 6 months after the index PCI all patients underwent an echocardiographic examination and such parameters as end-diastolic volume (EDV), left ventricular ejection fraction (EF) and contractility index (WMSI) were calculated.
The patients were divided into two groups: group 1 with impaired myocardial reperfusion (MBG 0-1) (n=32) and group 2 with adequate tissue reperfusion (MBG 2-3) (n=60). Negative left ventricular remodelling was observed more frequently in group 1 than in group 2 (28.1% vs 10%, p=0.029). More patients in group 1 presented heart failure symptoms (56.3% vs 25%, p=0.013).
Failure of tissue reperfusion assessed by means of angiographic indices (MBG 0-1) in patients with myocardial infarction treated with primary coronary angioplasty is associated with a higher rate of adverse myocardial remodelling and heart failure at 6 months after myocardial infarction.
病理性左心室重构被认为是心肌梗死后患者发生心力衰竭的主要原因。
本研究旨在评估采用血管造影心肌 blush 分级（MBG）量表评估的冠状动脉微血管再灌注程度与接受直接冠状动脉血管成形术治疗的急性心肌梗死患者不良左心室重构之间的相关性。
本研究纳入了 92 例因首次前壁心肌梗死入院且成功接受（TIMI-3 级血流）直接冠状动脉血管成形术的连续患者。评估血管造影心肌再灌注参数（MBG、校正 TIMI 帧数）。在首次 PCI 术后 3 天和 6 个月，所有患者均接受超声心动图检查，并计算舒张末期容积（EDV）、左心室射血分数（EF）和收缩性指数（WMSI）等参数。
患者被分为两组：第 1 组为心肌再灌注受损（MBG 0 - 1）组（n = 32），第 2 组为组织再灌注充分（MBG 2 - 3）组（n = 60）。第 1 组中观察到的左心室不良重构比第 2 组更频繁（28.1% 对 10%，p = 0.029）。第 1 组中有更多患者出现心力衰竭症状（56.3% 对 25%，p = 0.013）。
在接受直接冠状动脉血管成形术治疗的心肌梗死患者中，通过血管造影指标（MBG 0 - 1）评估的组织再灌注失败与心肌梗死后 6 个月时不良心肌重构和心力衰竭的发生率较高相关。
