Department of Clinical Physiology, Lund University Hospital, Lund University, Lund, SE-221 85 Sweden.
BMC Cardiovasc Disord. 2010 Jan 18;10:4. doi: 10.1186/1471-2261-10-4.
The time course of regional functional recovery following revascularization with regards to the presence or absence of infarction is poorly known. We studied the effect of the presence of chronic non-transmural infarction on the time course of recovery of myocardial perfusion and function after elective revascularization.
Eighteen patients (mean age 69, range 52-84, 17 men) prospectively underwent cine magnetic resonance imaging (MRI), delayed contrast enhanced MRI and rest/stress 99m-Tc-tetrofosmin single photon emission computed tomography (SPECT) before, one and six months after elective coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI).
Dysfunctional myocardial segments (n = 337/864, 39%) were classified according to the presence (n = 164) or absence (n = 173) of infarction. Infarct transmurality in dysfunctional segments was largely non-transmural (transmurality = 31 +/- 22%). Quantitative stress perfusion and wall thickening increased at one month in dysfunctional segments without infarction (p < 0.001), with no further improvement at six months. Despite improvements in stress perfusion at one month (p < 0.001), non-transmural infarction displayed a slower and lesser improvement in wall thickening at one (p < 0.05) and six months (p < 0.001).
Dysfunctional segments without infarction represent repetitively stunned or hibernating myocardium, and these segments improved both perfusion and function within one month after revascularization with no improvement thereafter. Although dysfunctional segments with non-transmural infarction improved in perfusion at one month, functional recovery was mostly seen between one and six months, possibly reflecting a more severe ischemic burden. These findings may be of value in the clinical assessment of regional functional recovery in the time period after revascularization.
关于存在或不存在梗塞的情况下，血运重建后区域性功能恢复的时间进程尚不清楚。我们研究了慢性非透壁梗塞的存在对选择性血运重建后心肌灌注和功能恢复时间进程的影响。
18 例患者（平均年龄 69 岁，范围 52-84 岁，17 名男性）前瞻性地接受了电影磁共振成像（MRI）、延迟对比增强 MRI 和静息/应激 99m-Tc-四氮唑单光子发射计算机断层扫描（SPECT）检查，分别在选择性冠状动脉旁路移植术（CABG）或经皮冠状动脉介入治疗（PCI）前、1 个月和 6 个月后进行。
根据是否存在梗塞（n = 164）或不存在梗塞（n = 173）将功能障碍性心肌节段（n = 337/864，39%）进行分类。功能障碍性节段的梗塞透壁性主要为非透壁性（透壁性=31 +/- 22%）。在无梗塞的功能障碍性节段中，应激灌注和壁增厚在 1 个月时增加（p < 0.001），6 个月时无进一步改善。尽管应激灌注在 1 个月时改善（p < 0.001），但非透壁性梗塞在 1 个月（p < 0.05）和 6 个月（p < 0.001）时的壁增厚改善较慢且较少。
无梗塞的功能障碍性节段代表重复顿抑或冬眠心肌，这些节段在血运重建后 1 个月内改善了灌注和功能，此后无进一步改善。尽管非透壁梗塞的功能障碍性节段在 1 个月时改善了灌注，但功能恢复主要在 1 至 6 个月之间，这可能反映了更严重的缺血负担。这些发现可能对血运重建后区域功能恢复的临床评估有价值。
