Department of Cardiology, Isala Clinics, location Weezenlanden, Zwolle, the Netherlands.
Neth Heart J. 2010 Jan;18(1):25-30.
Background. Myocardial blush grade (MBG) and myocardial contrast echocardiography (MCE) are both indices for myocardial perfusion in patients with ST-elevation acute myocardial infarction (STEMI). We aimed to compare MBG with MCE in the infarct-related artery segment for assessing infarct size in patients with STEMI treated with primary percutaneous coronary intervention (PCI).Methods. 43 patients underwent successful (postprocedural TIMI flow 3) primary PCI for STEMI. MBG was assessed at the end of the PCI procedure and MCE was assessed 1.7+/-1.8 days after PCI. Enzymatic infarct size was estimated by measurementof enzyme activities by using lactate dehydrogenase (LDH) as the referenceenzyme. Cumulative enzyme release (LDHQ(48)) from at least five serial measurements up to 48 hours after symptom onset was calculated. Also peak creatine kinase, CK-MB and peak LDH were measured.Results. MBG 0/1, 2 and 3 were observed in 14, 12 and 17 patients, respectively, and was compared with tertiles of MCE. We found a parallel correlation between both MBG and MCE and LDHQ(48). However, there was no correlation between MCE and MBG. Patients with both normal MCE and a normal MBG had least myocardial damage and those with both impaired MCE and an impaired MBG had most myocardial damage.Conclusion. Both MBG and MCE are good predictors of infarct size in STEMI patients treated with PCI. However, these markers are not mutually related, possibly due to time-related changes in myocardial perfusion. Combining these two markers may yield a more accurate prediction of final myocardial damage. (Neth Heart J 2010;18:25-30.).
背景。心肌染色分级（MBG）和心肌声学造影（MCE）都是评估 ST 段抬高型急性心肌梗死（STEMI）患者心肌灌注的指标。我们旨在比较 MBG 与 MCE 在梗死相关动脉节段对接受直接经皮冠状动脉介入治疗（PCI）的 STEMI 患者梗死面积的评估作用。
方法。43 例 STEMI 患者成功接受直接 PCI 治疗。在 PCI 治疗结束时评估 MBG，在 PCI 治疗后 1.7+/-1.8 天评估 MCE。通过使用乳酸脱氢酶（LDH）作为参考酶测量酶活性来估计酶学梗死面积。根据症状发作后至少 5 次连续测量计算 48 小时内的累积酶释放（LDHQ（48））。还测量了肌酸激酶峰值、CK-MB 和 LDH 峰值。
结果。14、12 和 17 例患者分别观察到 MBG 0/1、2 和 3，将其与 MCE 的三分位数进行比较。我们发现 MBG 和 MCE 与 LDHQ（48）之间存在平行相关性。然而，MCE 和 MBG 之间没有相关性。MBG 和 MCE 均正常的患者心肌损伤最小，MBG 和 MCE 均受损的患者心肌损伤最大。
结论。MBG 和 MCE 都是接受 PCI 治疗的 STEMI 患者梗死面积的良好预测指标。然而，这些标志物彼此之间没有相关性，可能是由于心肌灌注的时间相关变化。联合使用这两种标志物可能会更准确地预测最终的心肌损伤。（荷兰心脏杂志 2010；18:25-30.）。
