经胸多普勒超声心动图评估的冠状动脉血流速度模式可预测成功的直接血管成形术后的不良临床事件和心肌恢复情况。

Coronary flow velocity pattern assessed by transthoracic Doppler echocardiography predicts adverse clinical events and myocardial recovery after successful primary angioplasty.

作者信息

Agostini Francesco, Iannone Maria Alessandra, Mazzucco Raffaele, Cionini Francesca, Baccaglioni Nicola, Lettieri Corrado, Belfanti Divo, Tomasi Luca, Izzo Antonio, Ferrari Maria Rosa, Brunazzi Maria Cristiana, Zanini Roberto

机构信息

Division of Cardiology, Carlo Poma Hospital, via Albertoni, no. 1, 46100 Mantua, Italy.

出版信息

J Cardiovasc Med (Hagerstown). 2006 Oct;7(10):753-60. doi: 10.2459/01.JCM.0000247323.57536.4d.

DOI:10.2459/01.JCM.0000247323.57536.4d

PMID:17001237

Abstract

BACKGROUND

Doppler guidewire studies demonstrated that specific velocity patterns in the left anterior descending coronary artery (LAD) after primary percutaneous coronary intervention (PCI) predict myocardial recovery and clinical outcome. The present study assessed whether similar results can be achieved by transthoracic Doppler echocardiography (TTDE).

METHODS

Coronary flow velocities of LAD were evaluated by TTDE in 35 consecutive patients with anterior acute myocardial infarction who were treated with successful primary PCI plus stenting, performed within 6 h after the onset of symptoms or within 6-12 h if there was evidence of continuing ischaemia. Coronary-flow velocity of the LAD was achieved after 12 h and within 48 h after the PCI; TTDE standard examination was repeated after 2 months of follow-up.

RESULTS

Three patterns were found: (i) 'pattern A' with good antegrade systolic flow and slow diastolic deceleration rate (63.7%); (ii) 'pattern B' with reduced or absent systolic flow and rapid diastolic deceleration rate (9.1%); and (iii) 'pattern C' with protosystolic retrograde flow and rapid diastolic deceleration rate (27.2%). The clinical characteristics and echocardiographic data were compared: wall-motion-score-index (WMSI), ejection fraction, end-diastolic volume (EDV) after PCI (T1) and after 2 months (T2). Patients with pattern A demonstrated recovery of contractile function (WMSI-T1 1.48 + or - 0.42/WMSI-T2 1.29 + or - 0.29, P < 0.05) and better clinical outcome; patients with patterns B and C ran into ventricular remodelling (EDV-T1 89 + or - 6.3 ml/EDV-T2 123 + or - 25 ml, P = 0.002) and more early and late complications.

CONCLUSIONS

TTDE is a reliable method to achieve coronary flow velocities in LAD after an anterior acute myocardial infarction and it could be useful to evaluate no-reflow phenomenon at bedside and thus clinical outcome.

摘要

背景

多普勒导丝研究表明，直接经皮冠状动脉介入治疗（PCI）后左前降支冠状动脉（LAD）中的特定血流速度模式可预测心肌恢复情况和临床结局。本研究评估经胸多普勒超声心动图（TTDE）是否能取得类似结果。

方法

连续35例前壁急性心肌梗死患者接受了成功的直接PCI加支架置入术，于症状发作后6小时内或有持续缺血证据时在6 - 12小时内行TTDE评估LAD的冠状动脉血流速度。PCI术后12小时内及48小时内获取LAD的冠状动脉血流速度；随访2个月后重复TTDE标准检查。

结果

发现三种模式：（i）“A模式”，收缩期前向血流良好且舒张期减速缓慢（63.7%）；（ii）“B模式”，收缩期血流减少或缺失且舒张期减速迅速（9.1%）；（iii）“C模式”，收缩前期逆向血流且舒张期减速迅速（27.2%）。比较了临床特征和超声心动图数据：室壁运动评分指数（WMSI）、射血分数、PCI后（T1）及2个月后（T2）的舒张末期容积（EDV）。A模式患者表现出收缩功能恢复（WMSI - T1 1.48±0.42/WMSI - T2 1.29±0.29，P < 0.05）且临床结局更好；B模式和C模式患者出现心室重构（EDV - T1 89±6.3 ml/EDV - T2 123±25 ml，P = 0.002）以及更多的早期和晚期并发症。