Tatli Ersan, Surucu Huseyin, Oztekin Erkan, Ulucay Abdullah, Ozcelik Fatih, Ozer Orhan, Aktoz Meryem
Department of Cardiology, Trakya University School of Medicine, Edirne, Turkey.
Saudi Med J. 2006 Oct;27(10):1468-72.
To detect the functional importance of coronary collaterals, which develop after acute myocardial infarctions (AMI).
Forty patients with acute AMI whose coronary angiography demonstrated a total occlusion of the left anterior descendant (LAD) artery were included in the study, between January 2003 and June 2004. All of the study patients underwent coronary angiography and left ventriculography using standard Judkins techniques (Phillips Integris-3000). Left ventricular (LV) free walls were divided into 5 segments, and all of these segments motions were evaluated then LV free wall motion score index (WMSI) was calculated. The study patients were divided into 2 groups: good (Rentrop 3; group I; n = 14) and poor coronary collateral circulation (Rentrop 0-2; group II; n = 26) according to the Rentrop grading. Then, color kinesis dobutamine stress echocardiography (CK-DSE) was performed to all patients with standard techniques 6 weeks after AMI.
There were no significant differences for age, gender, risk factors for the coronary artery disease and use of the fibrinolytic therapy between the groups. There were no significant statistical differences for angiographic WMSI, left ventricular ejection fraction (LVEF), end-diastolic volume, end-systolic volume and end-diastolic pressures between the 2 groups. No difference was detected between Group I and II for initial EF, WMSI and peak dose WMSI in CK-DSE procedure. Viability was determined in all of the 14 patients in group I (100%) and 12 of 26 patients in group II (46%) (p = 0.03).
In early periods of an AMI genesis of the coronary collateral circulation does not affect left ventricular global and regional systolic functions, but increase viability quite significantly. According to our findings early revascularization could be carried out in patients with good coronary collateral circulation without doing any test for viability.
检测急性心肌梗死（AMI）后形成的冠状动脉侧支循环的功能重要性。
纳入2003年1月至2004年6月间40例急性AMI患者，其冠状动脉造影显示左前降支（LAD）动脉完全闭塞。所有研究患者均采用标准Judkins技术（飞利浦Integris - 3000）进行冠状动脉造影和左心室造影。左心室（LV）游离壁分为5个节段，评估所有这些节段的运动，然后计算左心室游离壁运动评分指数（WMSI）。根据Rentrop分级，将研究患者分为2组：良好（Rentrop 3级；I组；n = 14）和冠状动脉侧支循环不良（Rentrop 0 - 2级；II组；n = 26）。然后，在AMI后6周，对所有患者采用标准技术进行彩色室壁运动分析多巴酚丁胺负荷超声心动图（CK - DSE）检查。
两组之间在年龄、性别、冠状动脉疾病危险因素及纤溶治疗的使用方面无显著差异。两组之间在血管造影WMSI、左心室射血分数（LVEF）、舒张末期容积、收缩末期容积和舒张末期压力方面无显著统计学差异。在CK - DSE检查中，I组和II组在初始EF、WMSI和峰值剂量WMSI方面未检测到差异。I组14例患者（100%）和II组26例患者中的12例（46%）检测到存活心肌（p = 0.03）。
在AMI早期，冠状动脉侧支循环的形成不影响左心室整体和局部收缩功能，但能显著提高存活心肌。根据我们的研究结果，对于冠状动脉侧支循环良好的患者，无需进行任何存活心肌检测即可早期进行血运重建。
