急性心肌梗死PCI后二维应变超声评估左室心肌功能的临床价值

目的:探讨急性心肌梗死(Acute myocardial infarction,AMI)患者经皮冠状动脉介入治疗(Percutaneous coronary intervention,PCI)后二维应变超声评估左室心肌功能的临床价值.方法:选取 2018 年9 月至 2020年 12 月医院收治的 72 例AMI患者为研究对象,患者PCI后均获得 6m随访结果,全部患者在术后第 3 d接受二维应变超声检查,记录参数(左心室整体径向应变(Global radial strain,GRS)、整体纵向应变(Global longitudinal strain,GLS)、整体周向应变(Global circumferential strain,GCS)).评估患者治疗后 6 m预后情况并分组,分析二维应变超声参数检查结果AMI患者PCI治疗后预后价值.结果:全部 72 例患者经评估,26 例预后不良,占 36.11％;预后不良组GRS、GLS、GCS均小于预后良好组(P＜0.05);二维应变超声GRS、GLS、GCS单独及联合评估AMI患者PCI治疗后预后不良的曲线下面积(Area under the curve,AUC)分别为 0.840、0.810、0.834、0.910,均有一定评估价值,且当GRS、GLS、GCS分别取 29.99％、11.18％、10.86％时,其敏感度以及特异度较高.结论:AMI患者在接受PCI治疗后获得二维应变超声检查结果,对患者预后风险有一定预测价值,可考虑将其用于风险预测及治疗指导.     

不同排便体位对经皮冠状动脉介入术后患者心肌耗氧量的影响

目的探讨不同排便体位对经皮冠状动脉介入术（percutaneous coronary intervention,PCI）后患者心肌耗氧量的影响。方法选取PCI术后患者110例,随机分为平卧位组和半卧位组,采用不同体位排便,记录排便过程中心率、血压变化,并计算心肌耗氧量。结果平卧位组患者排便时间为（16.21±6.12）min,半卧位组排便时间为（11.12±5.82）min。平卧位组患者排便较半卧位组费力,P〈0.05。平卧位组患者便前准备和便中后期阶段心率及平均动脉压均高于半卧位组,代表心肌耗氧量的D-P值也高于半卧位组,P〈0.05。结论 PCI术后患者半卧位排便体位可减少排便过程中心肌耗氧量的增加,半卧位可考虑作为PCI术后患者床上排便方式的首选。     

替格瑞洛治疗急性心肌梗死行经皮冠状动脉介入术后患者效果观察

目的:探究替格瑞洛片对急性心肌梗死(Acute myocardial infarction,AMI)行经皮冠状动脉介入术(Percutaneous coronary intervention,PCI)术后患者血凝状态、心功能及细胞炎症反应的影响.方法:选取我科2018年1月至2019年6月期间收治的127例AMI行PC...     

入院血糖对急性心肌梗死患者介入治疗后住院死亡率的预测价值

目的探讨入院即刻血糖水平对急性心肌梗死（AMI）患者行经皮冠状动脉介入（PCT）治疗后住院死亡率的预测价值。方法因急性心肌梗死在笔者所在医院行急诊PCI治疗的非糖尿病患者456例,其中男性319例,女性137例,年龄29～85岁,平均年龄61．30岁。按入院即刻血糖（SG）水平分为3组：SG〈7．8mmol/L为A组248例,7．8mmol／L≤SG≤11.1mmol／L为B组156例,SG〉11．1mmol/L为C组52例,分别对3组患者住院期间心力衰竭、恶性心律失常、心脏性死亡,再梗死、梗死后心绞痛及主要不良心脏事件（MACE）的发生率进行对比分析。结果在年龄、性别、冠心病家族史、吸烟、既往高血压、心房纤颤、前降支和右冠状动脉病变、多支病变、梗死后心绞痛、胸痛发作至PCI时间等方面3组之间差异均无统计学意义（P〉0．05）;而C组多于一个部位心肌梗死、入院Killip’s分级≥2级的比例明显多于A、B两组（P〈0．05）;C组白细胞计数明显高于A、B组（P〈0．05）;在肌酸激酶（CK）、肌酸激酶同功酶峰值（CK／CK—MB）及住院期间左心室射血分数方面3组差异均有统计学意义（P〈0．05）;C组急性心力衰竭的发生率明显高于A、B组;C组心肌梗死再发生率亦高于A组,而B、C组未显示差异有统计学意义;C组恶性心律失常发生率明显高于A组,A、B组差异亦有统计学意义（P〈0．05）;而MACE发生率及住院期间死亡率分别为C组46．2％和13．7％,B组34．0％和4．5％,A组19．0％和1．6％,3组之间差异均有统计学意义（P〈0．001）。结论入院即刻血糖升高的急性心肌梗死患者实施急诊PCI治疗后院内死亡率及总的心血管事件发生率高,提示预后不良。     

心肌梗死模型家猪存活心肌的磁共振延迟成像评价

背景：心脏磁共振延迟成像被认为是极有前景的无创性判断心肌存活状态的影像检查手段。目前常用的对比剂Gd-DTPA存在过高或过低评价存活心肌和不可逆性梗死心肌,而坏死亲和性对比剂ECIII-600可以准确地反映坏死心肌的面积。 目的：对比冠脉内注射坏死亲和性对比剂在猪再灌注急性心肌梗死存活心肌诊断中的应用价值。 方法：三四个月龄普通家猪12头,建立急性再灌注心肌梗死动物模型,分别冠脉内注射0.1 mmol/kg Gd-DTPA或         0.005 mmol/kg ECIII-600。胸导R波触发心电门控,T1加权FAST序列,短轴面延迟强化扫描成像。扫描结束后沿短轴面将心脏切成6 mm断面行氯化三苯基四氮唑染色和光镜检查。比较相应层面的MRI延迟强化区和氯化三苯基四氮唑染色所示梗死区的关系。 结果与结论：注射Gd-DTPA的延迟成像10 min时强化区面积与氯化三苯基四氮唑染色相比过高估计梗死心肌面积约21%,30 min时强化区面积与氯化三苯基四氮唑染色结果一致,之后则过低估计坏死心肌的面积;注射ECIII-600的延迟磁共振成像在坏死区显示强烈而持续的对比增强,强化区面积与氯化三苯基四氮唑染色所示心肌梗死面积一致。说明ECIII-600增强磁共振延迟成像可以准确反映急性心肌梗死面积。Gd-DTPA评价心肌梗死面积不稳定,观察时间窗短,心脏磁共振成像应在对比剂注射后1 h以内完成。     

血清Hcy、PCT对急性心肌梗死患者急诊经皮冠状动脉介入治疗术后心肌低灌注的风险预测

目的:探讨血清同型半胱氨酸(homocysteine,Hcy)、降钙素原(procalcitonin,PCT)对急性心肌梗死(acute myocardial infarction,AMI)患者急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后心肌低灌注的风险预...     

心肌梗死患者介入术与易化介入术疗效的比较

目的回顾性分析直接经皮冠状动脉介入术(直接介入术,dPCI)与溶栓联合经皮冠状动脉介入术(易化介入术,FPCI)对心肌梗死的疗效、安全性影响。方法收集发病24h内行介入治疗的急性心肌梗死(AMI)患者,比较dPCI组(A)组和FPCI组(B组)的成功率和严重并发症发生率。结果两组在成功率、出血、靶血管并发症、再梗死方面相同,无显著性差异。A组从入院到导管室时间为3.7～21.5h,平均(6.4±3.8)h,B组从入院到接受静脉溶栓治疗时间为0.5～6.3h,平均(2.4±1.6)h,A组时间明显长于B组,有显著性差异,无复流现象及导管室事件如再灌注心律失常、心室颤动、低血压等方面,A组较B组明显多,有显著性差异。结论FPCI较dPCI有相同的成功率及更好的安全性,值得推广。     

存活心肌的检测及对介入治疗的指导价值

冠状动脉疾病患者出现局部或总体左室功能不全,左室射血分数降低,原因可能是不可逆性心肌损害,也可能是缺血后心肌冬眠、心肌顿抑等.使用非侵袭性的检测方法,将不可逆性心肌细胞从存活心肌中区分出来,及时进行血运重建,使其功能得以部分或完全的恢复,将会逆转左室功能、提高生活质量及改善预后.正确判断节段性室壁运动异常区域内有无存活心肌及其范围,对冠心病患者进一步选择治疗方案、预测疗效及判断预后有着重要的意义.     

急性心肌梗死急诊PCI术中再灌注心律失常临床分析

目的探讨急性心肌梗死急诊PCI术中发生再灌注心律失常的特点和临床意义。方法174例急性心肌梗死患者行急诊PCI,按PCI手术开始时间不同、梗死相关血管是否完全闭塞及梗死相关血管三种情况,对其术中再灌注心律失常发生情况进行对比分析。结果6h内开通冠脉,再灌注心律失常发生率显著高于6~12h开通冠脉;血管完全闭塞组再灌注心律失常发生率显著高于次全闭塞组;LAD组发生快速心律失常多见,RCA组发生缓慢心律失常多见。结论急性心肌梗死患者在行急诊PCI中,再灌注心律失常发生率较高,尤其是早期及血管完全闭塞者,心律失常的类型与梗死相关血管有明确相关性。     

老老年急性心肌梗死患者介入治疗的疗效及近期安全性评价

目的评价老老年（≥80岁）急性心肌梗死（AMI）患者行急诊与择期经皮冠状动脉介入治疗术（PCI）的有效性和近期安全性。方法将120例老老年冠心病患者分为急性心肌梗死组（AMI组）和非心肌梗死组（对照组）,其中AMI组发病12h内行直接PCI的患者为AMI急诊组,其他AMI患者（AMI择期组）和对照组患者均行择期PCI,两组合称为非急诊组,对各组的临床资料及冠脉介入特点进行回顾性分析。结果 AMI急诊组PCI即刻成功率（72.2%）低于非急诊组（92.2%）,差异有统计学意义（P=0.036）。AMI急诊组并发症比非急诊组和AMI择期组高,差异有统计学意义（P〈0.001,P=0.039）,AMI组并发症及主要不良心脏事件发生率、院内死亡率均比对照组高（P〈0.05）。结论在老老年AMI患者中,急诊与择期PCI手术成功率均较高,虽然急诊PCI术发生并发症的风险较高,但两者在院内死亡率和主要不良心脏事件发生率方面差异无统计学意义。     

Segment-orientated analysis of two-dimensional strain and strain rate as assessed by velocity vector imaging in patients with acute myocardial infarction

Aims: Strain rate imaging techniques have been proposed for the detection of ischemic or viable myocardium in coronary artery disease, which is still a challenge in clinical cardiology. This retrospective comparative study analyzed regional left ventricular function and scaring with two-dimensional strain (2DS) in the first 4 to 10 days after acute anterior myocardial infarction (AMI).Methods and results: The study population consisted of 32 AMI patients with an LAD occlusion and successful reperfusion. The assessment of peak systolic 2DS and peak systolic strain rate (SR) was performed segment-oriented with the angle-independent speckle tracking algorithm Velocity Vector Imaging (VVI). The infarcted, adjacent and non-infarcted segments were revealed by late enhancement MRI (LE-MRI), which was used as reference for the comparison with 2DS. The infarcted segments showed a significant decrease of tissue velocities, 2DS and SR in comparison to the non-affected segments.Conclusion: 2DS and SR as assessed by VVI seem to be a suitable approach for echocardiographic quantification of global and regional myocardial function as well as a promising tool for multimodal risk stratification after anterior AMI.     

Adrenomedullin concentrations at two time points following myocardial infarction and prediction of mid-term outcomes

Introduction

Adrenomedullin (ADM) is a vasopeptide with multiple actions in the cardiovascular system and a potentially powerful tool in comparison to some of the well-established unimodal biomarkers of risk stratification in myocardial infarction (MI). Previous studies on ADM in acute MI were based on single assessment. Therefore the aim of the study was to examine the relation between ADM plasma concentrations assessed at different time points following MI and outcomes.

Material and methods

The study included 127 patients with acute MI treated with percutaneous coronary intervention and 60 healthy individuals as controls. Adrenomedullin concentration was assessed at baseline in all study subjects and 48 h after admission in patients with MI. The primary endpoint consisted of all-cause death, nonfatal myocardial infarction, stroke and the need of target vessel revascularization at 6-month follow-up.

Results

Mean ADM plasma concentration on admission was higher in patients with MI than in controls (30.3 ±14.3 pmol/l vs. 14.6 ±4.7 pmol/l, p < 0.0001). There was no significant difference between ADM concentration after 48 h (30.6 ±12.3 pmol/l) and on admission. The primary endpoint occurred in 9.4% of patients with MI. Multivariable analysis showed that ADM concentration at 48 h after admission (OR = 2.121, 95% CI 1.180-3.810 for every increase of 10 pmol/l, p = 0.012) was the only independent predictor of the primary endpoint.

Conclusions

In patients with acute MI adrenomedullin plasma concentration assessed at 48 h after admission, but not ADM concentration at baseline, is an independent predictor of major adverse cardiovascular events at mid-term follow-up.     

Efficacy and safety of bivalirudin bridging enoxaparin versus fondaparinux in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: evidence from a single-center study

IntroductionThis study aims to compare the safety and efficacy of bivalirudin bridging enoxaparin versus fondaparinux in patients with acute myocardial infarction (AMI) who were undergoing primary percutaneous coronary intervention (PPCI).MethodsThe study is a prospective, natural, and selective interventional trial based on real-world data for 482 AMI patients.ResultsAt the end of the follow-up, the two groups demonstrated similar major adverse cardiovascular and cerebrovascular events (MACCE) and bleeding rates. After propensity score matching (PSM), the fondaparinux group showed greater advantages in reducing MACCE and bleeding events.ConclusionsThe anticoagulation strategy of bivalirudin bridging fondaparinux seems to be superior to that of bivalirudin bridging enoxaparin in patients with AMI undergoing PPCI.     

Influence of concomitant heparin administration on pregnancy-associated plasma protein-A levels in acute coronary syndrome with ST segment elevation

Introduction

The time course of pregnancy-associated plasma protein-A (PAPP-A) levels was studied at admission, immediately after percutaneous coronary intervention (PCI) and 1, 2, 4, 6, 12, 24 and 48 h after PCI in acute coronary syndrome with ST segment elevation (ACS-STE) to determine the impact of PCI, concomitant clinical complications and heparin administration.

Material and methods

Pregnancy-associated plasma protein-A serum levels, examined by the Kryptor^TM system, were studied in 30 heparinized PCI ACS-STE patients, in 10 elective PCIs and 12 coronary angiographies with heparin, and in 5 patients with normal coronary angiogram without heparin.

Results

Heparin caused a high PAPP-A increase in ACS-STE patients, in all patients with heparin without ACS and angiographic signs of significant atherosclerosis. This increase was directly associated with heparin dosage and activated clotting time (ACT) (r = 0.71, p = 0.0001) and inversely with the interval between heparin applications and time of serum sampling. It was followed by a rapid decrease within 1 to 2 h and return to normal levels in 10 to 12 h. In ACS-STE patients the decrease was significantly slower than in heparinized elective PCI and angiography patients. The PAPP-A increase was not significantly dependent on the length of PCI. Persistent increase after 24 h was associated in 4/7 patients with concomitant clinical complications.

Conclusions

The diagnostic validity of PAPP-A can be verified only within the 1^st h after clinical onset of ACS before heparin administration, the prognostic value in heparinized patients not earlier than 12 h after the last heparin application, if ACT is normal and serious clinical concomitant complications are eliminated.     

丹红注射液对急性心肌梗死患者经皮冠状动脉介入治疗后血清IL-6和IL-17水平的影响

目的:探讨丹红注射液对急性心肌梗死(acute myocardial infarction,AMI)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)后血清IL-6和IL-17水平的影响.方法:选取2014年6月至2016年1月在第四军医大学唐都医院心内科急诊PCI术后的120例ST抬高型心肌梗死(ST-elevation myocardial infarction,STEMI)患者,随机分为对照组和研究组,每组各60例.两组均给予常规治疗,而研究组则在常规治疗基础上给予静脉滴注丹红注射液治疗.观察两组临床症状和体征的改善情况、心电图的恢复情况及不良反应发生情况,评估两组的临床疗效.ELISA测定两组患者治疗前和治疗3,7 d后血清IL-6和IL-17的水平.比较两组治疗前后左室射血分数和心肌梗死面积的变化.随访6个月,观察两组患者主要不良心血管事件(major adverse cardiovascular events,MACE)的发生情况.结果:研究组治疗的总有效率为90.00%,显著高于对照组的76.67%,两组间差异有统计学意义(P<0.05);研究组治疗3,7 d后血清IL-6水平分别为(56.38±10.75)ng/mL,(42.52±8.14)ng/mL,均显著低于对照组的(62.73±12.08)ng/mL,(51.65±9.78)ng/mL,两组间差异有统计学意义(P<0.05);研究组治疗3,7 d后血清IL-17水平分别为(28.73±5.68)ng/mL,(22.54±4.55)ng/mL,均显著低于对照组的(34.39±6.21)ng/mL和(29.82±5.74)ng/mL,两组间差异有统计学意义(P<0.05);研究组治疗后的LVEF为54.72%±5.64%,显著高于对照组的49.38%±4.57%,两组间差异有统计学意义(P<0.05);研究组治疗后的心肌梗死面积为10.64%±4.38%,明显低于对照组的16.74%±5.49%,两组间差异有统计学意义(P<0.05);研究组的MACE发生率为5.00%,显著低于对照组的16.67%,两组间差异有统计学意义(P<0.05).结论:丹红注射液可有效降低PCI术后STEMI患者血清L-6和IL-17的水平,改善患者心功能,缩小心肌梗死面积,降低MACE的发生率,安全有效,值得应用于临床.     

急性心肌梗死介入治疗进展

血栓形成确认为急性心肌梗死的病理基础后 ,80年代起再灌注治疗开创了急性心肌梗死 (ＡＭＩ)治疗的里程脾。多项临床试验证实静脉溶栓治疗显著降低了心肌梗死 (ＭＩ)的死亡率 ,大大改善了心肌梗死患者的预后。然而 ,静脉溶栓治疗仍有不足之处 ,如能接受溶栓治疗的患者仅 1/ 3,血管再通率只有 60 %～ 80 % ,而实际上溶栓后梗死相关血管冠状动脉造影达ＴＩＭＩ 3级血流 (即完全再灌注 )的仅50 %～ 55% ,ＴＩＭＩ 2级血流 (即部分再灌注 )虽达再灌注标准 ,但并不降低死亡率 ,Ａｎｄｅｒｓｏｎ等报告90ｍｉｎ梗死相关血管达ＴＩＭＩ 3级血流者 3…     

超声心动图曲线M型应变率成像研究冠心病心肌缺血

目的应用曲线M型应变率成像（CMM-SRI）技术研究冠心病缺血心肌的图像特点，重点探讨收缩-舒张转换时间（Tcec）的改变。方法冠心病组和正常对照组各60例，观察左心室CMM-SRI图像特点，定量检测各节段Tcec，冠状动脉造影确定缺血节段，比较冠心病组左心室壁各节段与对照组之间Tcec的差异。结果无缺血节段的室壁，CMM-SRI图像红、蓝颜色转换的交界线基本呈直线，有缺血节段的室壁，交界线呈不规则曲线；缺血节段Tcec延长，与对照组比较绝大多数缺血节段差异有统计学意义。结论CMM-SRI可定量分析缺血心肌Tcec的改变，提示CMM-SRI技术可用于检测缺血心肌。     

Scavenger receptor A index and coronary thrombus in patients with acute ST elevation myocardial infarction

To examine the relationship between the scavenger receptor A (SRA) index (the number of SRA+ cells observed in 10 high power fields of peripheral blood (PB) smear samples; normal upper limit <30) and coronary thrombus, 389 thrombi obtained from 393 patients with acute ST elevation myocardial infarction were examined. Thrombi were classified into platelets (PT), mixed (MT), fibrin-rich (FT) and organizing thrombi (OT); 387, 269, 57 and 29 cases were detected, respectively. Patients were divided into group A (PT only, 89 cases), B (containing MT and PT but not FT, 243 cases), and C (containing FT, 57 cases). SRA+ cells had infiltrated into all FT cases and 147 of the 269 MT, but no PT. At hospitalization, the SRA index exceeded 30 in 276 patients. PT was observed in 274 cases, and MT and FT (residual mural thrombus; RMT) observed in 230. Infarct-related coronary artery was thought to be totally and rapidly occluded by PT that had formed as a result of severe stenosis due to extrusion of plaque content or growth of RMT. An abnormal increase of SRA+ cells is considered to be a useful finding to detecting the presence of PT and, probably, RMT.