Streb Witold, Duszańska Agata, Stabryła-Deska Joanna, Pluta Sławomir, Swierad Marcin, Was Tomasz, Kalarus Zbigniew, Kukulski Tomasz
Silesian Centre for Heart Disease in Zabrze, Poland.
Cardiol J. 2008;15(6):548-54.
Prediction of functional myocardial recovery post acute myocardial infarction should be based not only on flow patency of the infarct related artery (IRA) but also on the quality of microcirculation in at-risk segments. Myocardial blush grade (MBG) is a method of perfusion assessment which has an established value in prediction of both ventricular remodelling and prognosis. However, its invasive character encourages the search for other methods able to reflect myocardial recovery following successful reperfusion. Echocardiography is an imaging modality which has the potential to assess, noninvasively, myocardial perfusion and, quantitatively, the loss of contractile function. The aim of this study was to compare the values of myocardial contrast echocardiography (MCE), MBG and tissue Doppler imaging (TDI) in the assessment of microcirculation in patients with first acute myocardial infarction of the anterior wall.
The study group consisted of 39 patients (15 female and 24 male, mean age 58.8 +/- 12.2 years) with first anterior infarction within 6 hours of chest pain onset. All patients underwent angioplasty of the anterior descending artery (LAD). Myocardial blush grade was assessed directly after angioplasty, whereas MCE using SonoView contrast accompanied by TDI study was performed 4 days thereafter.
Neither of the quantitative MCE parameters showed significant correlation with perfusion assessed by MBG. Significant negative correlation of MBG was found with maximal systolic strain ( e) (R = -0.51, p = 0.003) and post systolic shortening (R = -0.49, p = 0.007) in infarcted segments, but this was not the case with the unaffected segments.
Use of MCE in the assessment of myocardial perfusion in myocardial infarction is limited, as shown by poor correlation with MBG. The presence of impaired contractile function by TDI corresponds better with myocardial perfusion than MCE does.
急性心肌梗死后功能性心肌恢复的预测不仅应基于梗死相关动脉（IRA）的血流通畅情况，还应基于危险节段的微循环质量。心肌 blush 分级（MBG）是一种灌注评估方法，在预测心室重构和预后方面具有既定价值。然而，其侵入性促使人们寻找其他能够反映成功再灌注后心肌恢复情况的方法。超声心动图是一种成像方式，有潜力无创地评估心肌灌注，并定量评估收缩功能丧失情况。本研究的目的是比较心肌对比超声心动图（MCE）、MBG 和组织多普勒成像（TDI）在评估首次前壁急性心肌梗死患者微循环中的价值。
研究组由 39 例患者（15 例女性和 24 例男性，平均年龄 58.8±12.2 岁）组成，这些患者在胸痛发作后 6 小时内发生首次前壁梗死。所有患者均接受了前降支动脉（LAD）血管成形术。血管成形术后直接评估心肌 blush 分级，而在 4 天后使用 SonoView 造影剂进行 MCE 并伴有 TDI 研究。
MCE 的定量参数均与 MBG 评估的灌注无显著相关性。在梗死节段中，发现 MBG 与最大收缩期应变（e）（R = -0.51，p = 0.003）和收缩后缩短（R = -0.49，p = 0.007）存在显著负相关，但在未受影响节段中并非如此。
如与 MBG 的相关性较差所示，MCE 在评估心肌梗死心肌灌注中的应用有限。TDI 显示的收缩功能受损与心肌灌注的对应关系比 MCE 更好。
