Olszowska Maria, Kostkiewicz Magdalena, Podolec Piotr, Rubis Paweł, Tracz Wiesława
Department of Cardiac and Vascular Disease, Institute of Cardiology, Collegium Medicum of the Jagielloniam University, 31-202 Krakow, Poland.
Echocardiography. 2010 Apr;27(4):430-4. doi: 10.1111/j.1540-8175.2009.01034.x. Epub 2010 Mar 19.
This study aimed to assess the role of myocardial contrast echocardiography (MCE) as a predictor of cardiac events and death in patients with acute myocardial infarction (AMI).
Eighty-six patients underwent primary percutaneous coronary angioplasty for AMI. Segmental perfusion was estimated by MCE in real time at mean 5 days after PCI using low MI (0.3) after 0.3-0.5 ml bolus injection of intravenous Optison. MCE was scored semiquantitatively as: (1) normal perfusion (homogenous contrast effect), (2) partial perfusion (patchy myocardial contrast enhancement), (3) lack of perfusion (no visible contrast effect). A contrast score index (CSI) was calculated as the sum of MCE scores in each segment divided by the total number of segments. The patients were followed up for cardiac events and death.
A CSI of >1.68 was taken to be a predictor of cardiac events and death. Death occurred only in patients with CSI >1.68. Patients with CSI >1.68 had a significantly (P = 0.03) higher incidence of cardiac death or cardiac events (75%) compared to those with CSI <1.68 (27%). The absence of residual perfusion within the infarct zone was an independent predictor of death and cardiac events (P = 0.02).
The absence of residual myocardial viability in the infarct zone supplied by an infarct-related artery is a powerful predictor of cardiac events in patients after AMI.
本研究旨在评估心肌对比超声心动图（MCE）作为急性心肌梗死（AMI）患者心脏事件和死亡预测指标的作用。
86例AMI患者接受了直接经皮冠状动脉介入治疗。PCI术后平均5天时，采用低机械指数（0.3），在静脉注射0.3 - 0.5 ml欧乃影微泡后，通过MCE实时评估节段灌注情况。MCE进行半定量评分如下：（1）正常灌注（均匀造影剂增强效果），（2）部分灌注（斑片状心肌造影增强），（3）无灌注（无可见造影剂增强效果）。计算对比评分指数（CSI），即各节段MCE评分总和除以节段总数。对患者进行心脏事件和死亡情况随访。
CSI>1.68被视为心脏事件和死亡的预测指标。仅CSI>1.68的患者发生了死亡。与CSI<1.68的患者（27%）相比，CSI>1.68的患者心脏死亡或心脏事件发生率显著更高（75%，P = 0.03）。梗死区内无残余灌注是死亡和心脏事件的独立预测指标（P = 0.02）。
梗死相关动脉供血的梗死区内无残余心肌存活能力是AMI患者心脏事件的有力预测指标。
