Ishihara M, Sato H, Tateishi H, Kawagoe T, Shimatani Y, Kurisu S, Sakai K
Department of Cardiology, Hiroshima City Hospital, Japan.
Am J Cardiol. 1996 Nov 15;78(10):1103-8. doi: 10.1016/s0002-9149(96)90060-0.
To evaluate the time course of coronary flow reserve after reperfusion, 14 patients with a first anterior wall acute myocardial infarction who underwent successful coronary angioplasty within 6 hours after symptom onset were studied. After angioplasty, coronary flow reserve of the left anterior descending artery was measured with a coronary Doppler guidewire and intravenous dipyridamole (0.56 mg/kg over 4 minutes). Measurements were repeated at predischarge (16 +/- 3 days, n = 12) and at follow-up (6 +/- 3 months, n = 9). Patients with restenosis at the time of repeat catheterization were excluded. An additional 13 patients with normal angiograms served as reference patients. Coronary flow reserve was 1.33 +/- 0.29 after angioplasty. It increased to 1.88 +/- 0.36 at predischarge (p <0.01) and further to 2.34 +/- 0.38 at follow-up (p <0.01 vs after angioplasty and at predischarge, respectively). However, compared with reference patients (3.15 +/- 0.48), coronary flow reserve was significantly reduced in the infarct patients even at follow-up (p <0.01). In infarct patients, the infarct region wall motion was initially -3.86 +/- 0.67 SD/chord. It significantly improved to -2.07 +/- 1.04 SD/chord at predischarge (p <0.01) and to -1.67 +/- 1.43 SD/chord at follow-up (p <0.01). However, there was no significant relation between coronary flow reserve and region wall motion after angioplasty (r = 0.10), at predischarge (r = 0.35), and at follow-up (r = 0.28). Thus, coronary flow reserve is severely impaired early after reperfusion. Coronary flow reserve improves over 2 weeks, but the impairment persists at 6 months after acute myocardial infarction. The impairment of coronary flow reserve cannot be predicted by left ventricular function. Small sample size is a potential limitation of this study, and a larger study should be performed to confirm these findings.
为评估再灌注后冠状动脉血流储备的时间进程，对14例首次发生前壁急性心肌梗死且在症状发作后6小时内行成功冠状动脉血管成形术的患者进行了研究。血管成形术后，使用冠状动脉多普勒导丝和静脉注射双嘧达莫（4分钟内0.56mg/kg）测量左前降支的冠状动脉血流储备。在出院前（16±3天，n = 12）和随访时（6±3个月，n = 9）重复测量。重复导管插入术时出现再狭窄的患者被排除。另外13例血管造影正常的患者作为对照患者。血管成形术后冠状动脉血流储备为1.33±0.29。出院前增加至1.88±0.36（p<0.01），随访时进一步增加至2.34±0.38（分别与血管成形术后和出院前相比，p<0.01）。然而，与对照患者（3.15±0.48）相比，梗死患者即使在随访时冠状动脉血流储备也显著降低（p<0.01）。在梗死患者中，梗死区域壁运动最初为-3.86±0.67 SD/弦。出院前显著改善至-2.07±1.04 SD/弦（p<0.01），随访时改善至-1.67±1.43 SD/弦（p<0.01）。然而，血管成形术后、出院前和随访时冠状动脉血流储备与区域壁运动之间均无显著相关性（r分别为0.10、0.35和0.28）。因此，再灌注后早期冠状动脉血流储备严重受损。冠状动脉血流储备在2周内有所改善，但在急性心肌梗死后6个月时这种损害仍然存在。冠状动脉血流储备的损害不能通过左心室功能来预测。小样本量是本研究的一个潜在局限性，应进行更大规模的研究来证实这些发现。
