Montisci Roberta, Ruscazio Massimo, Tona Francesco, Corbetti Francesco, Sarais Cristiano, Marchetti Maria Francesca, Cacciavillani Luisa, Iliceto Sabino, Perazzolo Marra Martina, Meloni Luigi
Clinical Cardiology, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy.
Clinical Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
Echocardiography. 2019 May;36(5):844-853. doi: 10.1111/echo.14337. Epub 2019 Apr 19.
Few studies have examined the effect of transmurality of myocardial necrosis on coronary microcirculation. The aim of this study was to examine the influence of cardiac magnetic resonance-derived (GE-MRI) structural determinants of coronary flow reserve (CFR) after anterior myocardial infarction (STEMI), and their predictive value on regional functional recovery.
Noninvasive CFR and GE-MRI were studied in 37 anterior STEMI patients after primary coronary angioplasty. The wall motion score index in the left descending anterior coronary artery territory (A-WMSI) was calculated at admission and follow-up (FU). Recovery of regional left ventricular (LV) function was defined as the difference in A-WMSI at admission and FU. The necrosis score index (NSI) and transmurality score index (TSI) by GE-MRI were calculated in the risk area. Baseline (BMR) and hyperemic (HMR) microvascular resistance, arteriolar resistance index (ARI), and coronary resistance reserve (CRR) were calculated at the Doppler echocardiography.
Bivariate analysis indicated that the CPK and troponin I peak, heart rate, NSI, TSI, BMR, the ARI, and CRR were related to CFR. Multivariable analysis revealed that TSI was the only independent determinant of CFR. The CFR value of >2.27, identified as optimal by ROC analysis, was 77% specific and 73% sensitive with accuracy of 76% in identifying patients with functional recovery.
Preservation of microvascular function after AMI is related to the extent of transmurality of myocardial necrosis, is an important factor influencing regional LV recovery, and can be monitored by noninvasive CFR.
很少有研究探讨心肌坏死透壁性对冠状动脉微循环的影响。本研究旨在探讨急性ST段抬高型心肌梗死（STEMI）后心脏磁共振成像（GE-MRI）得出的冠状动脉血流储备（CFR）结构决定因素的影响，及其对局部功能恢复的预测价值。
对37例接受直接冠状动脉血管成形术的前壁STEMI患者进行无创CFR和GE-MRI研究。计算入院时和随访时左前降支冠状动脉区域的壁运动评分指数（A-WMSI）。局部左心室（LV）功能的恢复定义为入院时和随访时A-WMSI的差值。通过GE-MRI计算风险区域的坏死评分指数（NSI）和透壁评分指数（TSI）。在多普勒超声心动图上计算基线（BMR）和充血（HMR）微血管阻力、小动脉阻力指数（ARI）和冠状动脉阻力储备（CRR）。
双变量分析表明，肌酸磷酸激酶和肌钙蛋白I峰值、心率、NSI、TSI、BMR、ARI和CRR与CFR相关。多变量分析显示，TSI是CFR的唯一独立决定因素。经ROC分析确定，CFR值>2.27为最佳，在识别功能恢复患者时，特异性为77%，敏感性为73%，准确性为76%。
急性心肌梗死后微血管功能的保留与心肌坏死透壁程度有关，是影响局部左心室恢复的重要因素，可通过无创CFR进行监测。
