晚期经皮冠状动脉介入治疗对前壁心肌梗死患者左心室局部功能的改善作用

Improvements in Regional Left Ventricular Function Following Late Percutaneous Coronary Intervention for Anterior Myocardial Infarction.

作者信息

Adhyapak Srilakshmi M, Menon Prahlad G, Varghese Kiron, Mehra Abhinav, Lohitashwa S B, Fantini Fabio

机构信息

Department of Cardiology, St. John's Medical College Hospital, Bangalore, India.

Department of Biomedical Engineering, Duquesne University, Pittsburgh, PA, USA.

出版信息

Clin Med Insights Cardiol. 2017 Dec 17;11:1179546817746636. doi: 10.1177/1179546817746636. eCollection 2017.

BACKGROUND

Late revascularization following a myocardial infarction has questionable clinical benefit.

METHODS

We studied 13 patients with anterior wall myocardial infarction who underwent percutaneous coronary intervention within 2 weeks of the primary event, by quantitative analysis of 2-dimensional echocardiographic images. Endocardial segmentations of the left ventricular (LV) endocardium from the 4-chamber views were studied over time to establish cumulative wall displacements (CWDs) throughout the cardiac cycle.

RESULTS

Left ventricular end-systolic volume decreased to 42 ± 8 mL/body surface area ( = .034) and LV ejection fraction improved to 52% ± 7% ( = .04). Analysis of LV endocardial CWD demonstrated significant improvements in mid-systolic to late-systolic phases in the apical LV segments, from 3.5 ± 0.32 to 5.89 ± 0.43 mm ( = .019). Improvements in CWD were also observed in the late-diastolic phase of the cardiac cycle, from 1.50 ± 0.42 to 1.76 ± 0.52 mm ( = .04).

CONCLUSIONS

In our pilot patient cohort, following late establishment of infarct-related artery patency following an anterior wall myocardial infarction, regional improvements were noted in the LV apical segments during systole and late diastole.

背景

心肌梗死后的晚期血运重建临床获益存疑。

方法

我们对13例前壁心肌梗死患者进行了研究，这些患者在初次事件发生后2周内接受了经皮冠状动脉介入治疗，通过对二维超声心动图图像进行定量分析。对四腔心视图中左心室（LV）心内膜的内膜分割进行长期研究，以确定整个心动周期中的累积壁位移（CWDs）。

结果

左心室收缩末期容积降至42±8 mL/体表面积（P = .034），左心室射血分数提高至52%±7%（P = .04）。对左心室心内膜CWD的分析表明，左心室心尖段在收缩中期至收缩末期阶段有显著改善，从3.5±0.32 mm增至5.89±0.43 mm（P = .019）。在心动周期的舒张末期阶段也观察到CWD的改善，从1.50±0.42 mm增至1.76±0.52 mm（P = .04）。