Tsunoda T, Nakamura M, Wakatsuki T, Nishida T, Asahara T, Anzai H, Touma H, Mitsuo K, Soumitsu Y, Sakatani H, Nakamura S, Degawa T, Yamaguchi T
Third Department of Internal Medicine, Ohashi Hospital, Toho University Faculty of Medicine, Tokyo, Japan.
J Am Coll Cardiol. 1998 Aug;32(2):338-44. doi: 10.1016/s0735-1097(98)00228-9.
We evaluated the relationship between alterations in coronary flow velocity during the acute phase of acute myocardial infarction (AMI) and the recovery of left ventricular wall motion in patients who underwent successful primary angioplasty.
The status of the coronary microcirculation is the major determinant of the prognosis of patients who have had successful reperfusion after AMI. Animal studies have shown that dynamic changes in regional flow are associated with the extent of infarction. Evaluation of alterations in coronary flow velocity in infarcted arteries may provide information about microcirculatory damage.
Flow velocity of the distal anterior descending artery was continuously monitored with the use of a Doppler guide wire immediately after recanalization for 18 +/- 4 h in 19 patients who underwent successful primary angioplasty after anterior AMI. Subjects were divided into two groups on the basis of the time course of alterations in average peak velocity (APV). Group D consisted of patients who had progressive decreases in APV through the next day (n = 9), and Group I comprised patients with an increase in APV after a transient decline (n = 10). Ejection fraction (EF) and regional wall motion (RWM) were assessed by left ventriculography performed on admission and at discharge.
The APV at the end of monitoring was greater in group I than in group D. In group I, EF and RWM were significantly improved at discharge. The change in EF was greater in group I than in group D (17 +/- 9% vs. 4 +/- 9%, p = 0.007), as was the change in RWM (0.96 +/- 0.23 vs. 0.13 +/- 0.36 SD/chord, p < 0.0001).
The alteration in flow velocity in recanalized infarcted arteries is related to left ventricular recovery. A progressive decrease in velocity after angioplasty implies no reflow, which is associated with a poor recovery of left ventricular function. Reperfusion injury may account in part for this phenomenon.
我们评估了急性心肌梗死（AMI）急性期冠状动脉血流速度改变与接受成功直接血管成形术患者左心室壁运动恢复之间的关系。
冠状动脉微循环状态是AMI后成功再灌注患者预后的主要决定因素。动物研究表明，局部血流的动态变化与梗死范围有关。评估梗死动脉中冠状动脉血流速度的改变可能提供有关微循环损伤的信息。
对19例前壁AMI后接受成功直接血管成形术的患者，在再通后立即使用多普勒导丝连续监测前降支远端血流速度18±4小时。根据平均峰值速度（APV）改变的时间进程将受试者分为两组。D组由次日APV逐渐降低的患者组成（n = 9），I组由短暂下降后APV增加的患者组成（n = 10）。入院时和出院时通过左心室造影评估射血分数（EF）和局部壁运动（RWM）。
监测结束时I组的APV高于D组。在I组中，出院时EF和RWM显著改善。I组的EF变化大于D组（17±9%对4±9%，p = 0.007），RWM变化也是如此（0.96±0.23对0.13±0.36 SD/弦，p < 0.0001）。
再通梗死动脉中的血流速度改变与左心室恢复有关。血管成形术后速度逐渐降低意味着无复流，这与左心室功能恢复不良有关。再灌注损伤可能部分解释了这一现象。
