Adhyapak Srilakshmi M, Menon Prahlad G, Varghese Kiron, Mehra Abhinav, Lohitashwa S B, Fantini Fabio
Department of Cardiology, St. John's Medical College Hospital, Bangalore, India.
Department of Biomedical Engineering, Duquesne University, Pittsburgh, PA, USA.
Clin Med Insights Cardiol. 2017 Dec 17;11:1179546817746636. doi: 10.1177/1179546817746636. eCollection 2017.
Late revascularization following a myocardial infarction has questionable clinical benefit.
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.
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).
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.
心肌梗死后的晚期血运重建临床获益存疑。
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）。
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）。
在我们的试点患者队列中，前壁心肌梗死后梗死相关动脉通畅延迟建立后，在收缩期和舒张末期左心室心尖段出现了局部改善。
