Rechavia E, de Silva R, Nihoyannopoulos P, Lammertsma A A, Jones T, Maseri A
Medical Research Council Cyclotron Research Unit, Hammersmith Hospital, Royal Postgraduate Medical School, London, United Kingdom.
Eur Heart J. 1995 Dec;16(12):1845-50. doi: 10.1093/oxfordjournals.eurheartj.a060838.
During and after myocardial infarction (MI), compensatory contractile and structural changes taking place in the remote uninvolved myocardial regions have been well described, in both experimental and clinical settings. However, quantitative information on the changes in perfusion in these regions in relation to their altered contractile function have not been available. This study was designed to assess the in vivo relationship between contractile function and perfusion in remote uninvolved hypercontractile myocardial regions, subtended by angiographically normal coronary arteries in patients with MI and single-vessel coronary artery disease. We utilized two-dimensional echocardiography and 15O-water positron emission tomography imaging to assess regional contractile function and myocardial blood flow, respectively. Measurements were performed in nine patients with single-vessel coronary artery disease and angiographically confirmed recanalization of the infarct-related artery, 1-2 days after MI (group A). Only patients demonstrating severely impaired wall motion of the infarcted area and reactive hypercontractility of the remote uninvolved regions were enrolled. Seven patients with previous non-reperfused MI (6-8 months post-MI) served as a control (group B). Systolic wall thickening and regional myocardial blood flow data sets were created for the remote myocardial segments perfused by angiographically detected patent coronary arteries by assigning regions on the tomograms to equivalent echocardiographic segments. In the remote regions, wall thickening and regional myocardial blood flow were higher in group A patients by 26% (43 +/- 6% vs 34 +/- 4%; P = 0.005) and 20% (1.06 +/- 0.15 vs 0.89 +/- 0.06 ml.g-1 per minute; P = 0.019), respectively. For both groups of patients, a significant correlation (r = 0.67; P = 0.004) between systolic wall thickening and regional myocardial blood flow was obtained. Infarcted regions in both groups showed no systolic wall thickening. In this selected group of patients these data demonstrate: (1) a proportionate increase in contractility and regional myocardial blood flow in uninvolved territories in patients with recent and old MI; (2) the in vivo relationship between contractile function and myocardial perfusion in man in these regions. When infarcted zones in both groups are equally affected, enhanced levels of catecholamines and sympathetic drive as well as different loading conditions may account for the hyperkinetic performance and consequently for the increased perfusion level in uninvolved segments in patients with recent MI.
在心肌梗死（MI）期间及之后，无论是在实验还是临床环境中，未受累心肌远端区域发生的代偿性收缩和结构变化都已有详尽描述。然而，关于这些区域灌注变化与其收缩功能改变之间的定量信息尚不可得。本研究旨在评估MI和单支冠状动脉疾病患者中，由血管造影显示正常的冠状动脉供血的未受累高收缩性心肌远端区域的收缩功能与灌注之间的体内关系。我们分别利用二维超声心动图和15O-水正电子发射断层扫描成像来评估区域收缩功能和心肌血流。对9名单支冠状动脉疾病且血管造影证实梗死相关动脉再通的患者在MI后1 - 2天进行测量（A组）。仅纳入梗死区域壁运动严重受损且未受累远端区域有反应性高收缩性的患者。7名既往未再灌注MI（MI后6 - 8个月）的患者作为对照（B组）。通过将断层图像上的区域对应到等效的超声心动图节段，为血管造影检测到的通畅冠状动脉供血的心肌远端节段创建收缩期壁增厚和区域心肌血流数据集。在远端区域，A组患者的壁增厚和区域心肌血流分别比B组高26%（43±6%对34±4%；P = 0.005）和20%（1.06±0.15对0.89±0.06 ml·g-1每分钟；P = 0.019）。对于两组患者，收缩期壁增厚与区域心肌血流之间均存在显著相关性（r = 0.67；P = 0.004）。两组的梗死区域均未显示收缩期壁增厚。在这组选定的患者中，这些数据表明：（1）近期和陈旧性MI患者未受累区域的收缩性和区域心肌血流成比例增加；（2）这些区域人体收缩功能与心肌灌注之间的体内关系。当两组的梗死区域受到同等程度影响时，儿茶酚胺和交感神经驱动水平的升高以及不同的负荷条件可能解释了近期MI患者未受累节段的高动力表现以及相应增加的灌注水平。
