[冠状动脉血流模式作为原发性冠状动脉血管成形术后功能恢复和短期左心室重构预测指标的价值。经胸多普勒研究]

[Value of coronary blood flow pattern as a predictor of functional recovery and short-term left ventricular remodeling after primary coronary angioplasty. A transthoracic Doppler study].

作者信息

de la Morena-Valenzuela Gonzalo, Florenciano-Sánchez Rafael, Rubio-Patón Ramón, González-Carrillo Josefa, Soria-Arcos Federico, Valdés-Chavarri Mariano

机构信息

Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.

出版信息

Rev Esp Cardiol. 2006 Apr;59(4):352-9.

PMID:16709388

Abstract

INTRODUCTION AND OBJECTIVES

Coronary blood flow measurement using a Doppler guidewire is the most sensitive way of detecting the no-reflow phenomenon following reperfusion of a myocardial infarction (MI). New high-frequency Doppler probes enable coronary blood flow velocity to be measured noninvasively. Our aims were to study the different patterns of left anterior coronary artery blood flow observed by transthoracic Doppler echocardiography, and to describe their association with functional recovery following reperfusion of an anterior MI.

METHODS

The study included 57 patients with a mean age of 60 years (range 30-85 years). An abnormal coronary blo:d flow pattern was defined as one in which there was a high peak diastolic velocity and a short deceleration time (i.e., < or = 500 ms). We compared the regional contractility, ventricular volumes, and left ventricular ejection fraction (LVEF) measured after 72 hours with those measured 1 month after MI.

RESULTS

Overall, 31 patients (54%) had a normal coronary blood flow pattern (Group 1) and 26 (46%), an abnormal pattern (Group 2). After one month, regional contractility improved in Group-1 patients, as did LVEF, from 46.8 (8.6) to 52.6 (8.8)% (P=.002). In these patients, left ventricular volumes were unchanged. In contrast, regional contractility and LVEF remained unchanged in Group-2 patients whereas ventricular volumes increased, from 55.8 (12.9) to 62.9 (16.8) ml/m2 (P=.05), and from 32.2 (9.5) to 37.1 (14.9) ml/m2 (P< .05). Coronary blood flow pattern was the most important independent predictor of left ventricular remodeling, odds ratio =6.14 (95% CI, 1.56-24.17).

CONCLUSIONS

Transthoracic Doppler echocardiographic assessment of coronary blood flow following reperfusion of an anterior myocardial infarction can be used to identify patients with microvascular damage who are progressing towards ventricular dilatation without recovery of myocardial function.

摘要

引言与目的

使用多普勒导丝测量冠状动脉血流是检测心肌梗死（MI）再灌注后无复流现象最敏感的方法。新型高频多普勒探头能够无创测量冠状动脉血流速度。我们的目的是研究经胸多普勒超声心动图观察到的左前冠状动脉血流的不同模式，并描述其与前壁心肌梗死再灌注后功能恢复的关系。

方法

该研究纳入了57例平均年龄60岁（范围30 - 85岁）的患者。异常冠状动脉血流模式定义为舒张期峰值速度高且减速时间短（即≤500毫秒）的模式。我们比较了MI后72小时和1个月时测量的局部收缩功能、心室容积和左心室射血分数（LVEF）。

结果

总体而言，31例患者（54%）具有正常冠状动脉血流模式（第1组），26例（46%）具有异常模式（第2组）。1个月后，第1组患者的局部收缩功能和LVEF均有所改善，LVEF从46.8（8.6）%提高到52.6（8.8）%（P = 0.002）。这些患者的左心室容积未发生变化。相比之下，第2组患者的局部收缩功能和LVEF保持不变，而心室容积增加，从55.8（12.9）ml/m²增加到62.9（16.8）ml/m²（P = 0.05），从32.2（9.5）ml/m²增加到37.1（14.9）ml/m²（P < 0.05）。冠状动脉血流模式是左心室重构最重要的独立预测因素，比值比 = 6.14（95%可信区间，1.56 - 24.17）。