Suryapranata H, Zijlstra F, MacLeod D C, van den Brand M, de Feyter P J, Serruys P W
Thoraxcenter, Erasmus University Hospital Rotterdam, The Netherlands.
Circulation. 1994 Mar;89(3):1109-17. doi: 10.1161/01.cir.89.3.1109.
The objective of the study was to determine the coronary vasodilatory reserve in reperfused myocardium in patients with acute myocardial infarction and its relation to regional myocardial function.
The study population consisted of 22 patients with acute myocardial infarction who underwent successful coronary angioplasty. The vasodilatory reserve in the reperfused myocardium was assessed quantitatively using computer-assisted digital subtraction cine-angiography immediately after angioplasty and at follow-up angiography before hospital discharge. Myocardial contrast medium appearance time and density were determined before and after pharmacological hyperemia induced by an intracoronary injection of 12.5 mg papaverine. Global and regional left ventricular functions were determined from contrast angiography. After papaverine, the mean contrast medium appearance time decreased significantly from 3.5 +/- 0.7 to 2.7 +/- 0.7 cardiac cycles (P < .000005) immediately after successful coronary angioplasty and from 3.8 +/- 0.7 to 2.7 +/- 0.9 cardiac cycles (P < .000005) at angiography before hospital discharge. The mean contrast medium density increased significantly from 48.7 +/- 13.8 to 61.0 +/- 19.0 pixels (P < .003) and from 49.6 +/- 19.7 to 80.3 +/- 29.6 pixels (P < .000005), respectively. As a consequence, the calculated coronary flow reserve increased significantly from 1.8 +/- 0.7 to 2.6 +/- 1.0 (P < .0008). The global ejection fraction increased significantly from 52 +/- 12% to 58 +/- 14% (P < .03), primarily because of a significant improvement in the regional myocardial function of the infarct zone from 20.8 +/- 9.0% to 26.0 +/- 10.5% (P < .001). Coronary flow reserve correlated well with regional myocardial function both during the acute phase (R = .79, P < .002) and at follow-up angiography (R = .82, P < .000004). Interestingly, coronary flow reserve measurement on reperfusion, immediately after angioplasty, correlated significantly with regional myocardial function at follow-up angiography (R = .81, P < .00003).
The results indicate that there is a pharmacologically inducible vasodilatory reserve in reperfused ischemic myocardium after successful coronary angioplasty in patients with acute myocardial infarction and that this is increased at 10-day follow-up angiography. More important, the degree of reactive hyperemic response on reperfusion has a predictive value regarding the ultimate degree of recovery of regional myocardial function. Quantitative assessment of reperfusion may be useful in investigating the role of coronary reperfusion and salvage of myocardial function.
本研究的目的是确定急性心肌梗死患者再灌注心肌中的冠状动脉血管舒张储备及其与局部心肌功能的关系。
研究对象为22例接受成功冠状动脉成形术的急性心肌梗死患者。使用计算机辅助数字减影电影血管造影术在血管成形术后即刻以及出院前随访血管造影时定量评估再灌注心肌中的血管舒张储备。在冠状动脉内注射12.5mg罂粟碱诱导药理学充血前后，测定心肌造影剂出现时间和密度。通过造影血管造影术确定整体和局部左心室功能。注射罂粟碱后，成功冠状动脉成形术后即刻，平均造影剂出现时间从3.5±0.7个心动周期显著缩短至2.7±0.7个心动周期（P<.000005），出院前血管造影时从3.8±0.7个心动周期缩短至2.7±0.9个心动周期（P<.000005）。平均造影剂密度分别从48.7±13.8像素显著增加至61.0±19.0像素（P<.003）和从49.6±19.7像素增加至80.3±29.6像素（P<.000005）。因此，计算得出的冠状动脉血流储备从1.8±0.7显著增加至2.6±1.0（P<.0008）。整体射血分数从52±12%显著增加至58±14%（P<.03），主要是因为梗死区域的局部心肌功能从20.8±9.0%显著改善至26.0±10.5%（P<.001）。在急性期（R=.79，P<.002）和随访血管造影时（R=.82，P<.000004），冠状动脉血流储备与局部心肌功能均具有良好的相关性。有趣的是，血管成形术后即刻再灌注时的冠状动脉血流储备测量值与随访血管造影时的局部心肌功能显著相关（R=.81，P<.00003）。
结果表明，急性心肌梗死患者成功冠状动脉成形术后，再灌注的缺血心肌存在药理学诱导的血管舒张储备，且在10天随访血管造影时增加。更重要的是，再灌注时反应性充血反应的程度对局部心肌功能最终恢复程度具有预测价值。再灌注的定量评估可能有助于研究冠状动脉再灌注的作用及心肌功能的挽救。
