心肌声学造影对急性心肌梗死急诊介入术后心肌灌注及预后评估

目的 通过实时心肌声学造影(MCE)评估急性心肌梗死（AMI）急诊介入术后微循环灌注情况及其对AMI预后的评估价值。方法纳入108例AMI且行急诊介入手术患者，术后3～5 d行心肌声学造影，记录患者左室射血分数（LVEF）、室壁运动评分指数（WMSI）、左室收缩末期容量（LVESV）、左室舒张末期容量（LVEDV）、左室舒张末期内径（LVIDd）、二尖瓣E峰速度（MVE）、二尖瓣A峰速度（MVA）、左室质量指数（Lvmassi）及造影剂评分指数（CSI）。出院后1年对108例患者进行电话随访，根据是否发生不良心血管事件（MACE）分为MACE组和非MACE组。结果（1）MACE组患者WMSI、CSI、LVESV更高，而LVEF则较低，两组差异有统计学意义(P<0.05)。（2）前壁心肌梗死MACE事件的发生和更多的心肌灌注缺损有关系。（3）CSI可以作为AMI急诊介入术后MACE事件发生的独立危险因素；（4）CSI≥1.58较 CSI<1.58的AMI患者1年后MACE事件发生率更高(45% vs. 9% P=0.001)。结论MCE能评估AMI急诊介入术后患者微循环灌注情况； CSI能独立预测AMI患者急诊介入术后MACE事件，从而对该类人群进行危险分层，尽早识别高危患者，规避恶性事件发生。

Evaluation of myocardial perfusion and prognosis in patients with acute myocardial infarction after emergency intervention by real-time myocardial contrast echocardiography

Objective To evaluate the value of myocardial contrast echocardiography (MCE) on microcirculation perfusion in patients with acute myocardial infarction (AMI) after emergency intervention and its prognosis value. Methods A total of 108 patients with AMI who underwent emergency interventional surgery was included in this study. MCE was performed 3-5 days after admission. The left ventricular ejection fraction (LVEF), wall motion score index (WMSI), left ventricular end-systolic volume (ESV), end-diastolic volume (EDV), left ventricular end-diastolic diameter (LVIDd), mitral E-peak velocity (MVE), mitral A-peak velocity (MVA), left ventricular mass index (Lvmassi), and contrast score index (CSI) were recorded. And then they were followed up by telephone one year after discharge, and divided into MACE group and non-MACE group depending on whether main adverse cardiovascular events (MACE events) occurred. Results The WMSI, CSI, and ESV were significantly higher in the MACE group, while the LVEF was significantly lower (P<0.05). The difference between the two groups was statistically significant. The MACE event of anterior myocardial infarction was associated with more myocardial perfusion defects. CSI can provide independent prediction of MACE in patients with AMI emergency intervention. The AMI patients with CSI ≥1.58 was taken to be a predictor of MACE. Patients with CSI ≥1.58 had a significantly higher incidence of cardiac death (45%) compared to those with CSI<1.58(9%). (P=0.001). Conclusion MCE can evaluate the microcirculation perfusion of patients with AMI after emergency intervention. CSI is a powerful predictor of MACE in patients with AMI after emergency intervention, and they can provided risk stratification to identify high-risk patients as early as possible.