心脏超声评价对急性心肌梗死的血流动力学研究进展

对近几年来各个期刊报道中的心脏超声评价急性心肌梗死的血流动力学研究方面的文献进行收集、整理与分析,利用中国知网、检索万方等大型数据库与国外数据库等网络工具,对有关心脏超声评价急性心肌梗死的血流动力学研究文献进行查阅,发现目前有关心脏超声评价的方式与手段主要集中在二维超声心动图、M型超声心动图、应变率显像技术、实时三维超...     

Two-dimensional and Doppler echocardiography in acute myocardial infarction and its complications

Two-dimensional echocardiography is an outstanding and unique bedside diagnostic and prognostic method for cardiologists facing the early diagnosis and complications of acute myocardial infarction. Its advantages are safety, rapidity, portability, and relatively low costs. It is suitable for evaluation of global and, more importantly, segmental myocardial function. Segmental wall motion analysis reliably detects, localizes, and estimates the extent of myocardial infarction in the first hours after onset of symptoms. In addition, it is the most sensitive method to diagnose right ventricular infarction and provides information predictive of early and late postinfarct complications. In postinfarct hemodynamic deterioration two-dimensional echocardiography allows one to distinguish primary pump failure from mechanical complications as: rupture of the free wall, of the ventricular septum or mitral valve dysfunction. In the subacute stage complications as ventricular (pseudo) aneurysm and thrombus may be diagnosed by two-dimensional echocardiography. Combined Doppler echocardiographic examination provides reliable information about the presence of insufficiency or shunting. Thus, echocardiography has become indispensable at the coronary care unit as it provides a complete picture of cardiac structure and function making it superior to most other methods in the clinical situation of an acute myocardial infarction with such a volatile and unpredictable course. This is an argument to house an echo/Doppler instrument in the coronary care unit.     

超声心动图诊断急性心肌梗死及其并发症的价值

目的评价超声心动图在急性心肌梗死及其并发症诊断中的应用价值。方法分析本院62例住院急性心肌梗死发病2周内患者的超声心动图特征，并将超声心动图与心电图对心肌梗死部位的判断结果进行比较，并注意观察有无急性心肌梗死并发症发生。结果超声心动图与心电图对心肌梗死部位及范围的判断基本相符。62例急性心肌梗死患者的超声心动图图像显示心肌梗死征象57例，并发症23例（室壁瘤11例，左室附壁血栓2例，室间隔穿孔3例，中、重度二尖瓣反流7例）。结论超声心动图可及时发现急性心肌梗死时心脏的一些特征性的形态和功能变化，检查方法简单准确，可与心电图相互印证与补充。     

Cardiac tamponade from ventricular rupture: value of two-dimensional echocardiography in guiding acute surgical management

In a patient with suspected cardiac tamponade after a recent myocardial infarction, the use of two-dimensional echocardiography rapidly clarified the underlying cause and provided additional diagnostic information useful in guiding acute surgical management.     

Role of certain factors in thrombus formation in patients with myocardial infarct complicated by an acute aneurysm

A total of 240 patients with acute myocardial infarction (MI) were examined over time with the use of two-dimensional echocardiography. The influence of such factors as the scope of involvement of the left ventricle myocardium, changes of its contractility and hemostasis on thrombus formation in the left ventricle was investigated. It was established that thrombus is formed primarily during anterior myocardial infarction with an extensive injury to the apical segment--formation of a large aneurysm. Thrombus formation is associated with a significantly large scope of the involvement and reduced (both total and segmental) left ventricle myocardial contractility, which may favour the development of hemostasis in the area of the aneurysm. It was discovered that two-dimensional echocardiography coupled with doppler cardiography is a highly sensitive technique, the use of which during MI enables recognizing patients predisposed to thrombus formation.     

Echocardiography and coronary artery disease: Current and future applications

Echocardiographic techniques are becoming more widespread for evaluating patients with known or suspected coronary artery disease. Because it affords an excellent overall view of the heart, two-dimensional echocardiography, rather than M-mode echocardiography, is the imaging procedure of choice when dealing with coronary artery disease. This technique can be used to make the initial diagnosis of acute myocardial infarction, diagnose complications, and assess prognosis following myocardial infarction. Additionally by combining this test with stress testing, latent coronary artery disease can be detected. Recovery of wall motion can be assessed following interventions such as thrombolysis or balloon angioplasty. Investigational and future uses include tissue characterization, which may allow detection of ischemic but potentially viable myocardium, direct coronary visualization for detection of atherosclerotic involvement of the proximal coronary arteries and myocardial contrast echocardiography. The latter technique allows visualization of perfusion by way of injecting contrast material into the coronary circulation. This has been demonstrated to be an accurate means of determining myocardial infarction size in an animal model and is currently being used in a number of centers in patients at the time of cardiac catheterization. In summary two-dimensional echocardiography currently allows assessment of patients with myocardial infarction from the time of their presentation through their convalescent period with respect to diagnosis, prognosis and presence of complications. Exercise echocardiography can diagnose latent coronary artery disease. The newer investigational techniques show promise for furthering our ability to evaluate patients with coronary artery disease using echocardiography.     

Determining the area of myocardial damage by the method of sectorial scanning and its value for prognosis of the outcome of acute myocardial infarction

The authors describe a method for measuring the myocardial injury area, and show the prognostic value of the latter based on examination of 100 patients admitted to the Cardioresuscitation Department with a diagnosis of acute transmural or large-focal myocardial infarction. The lifetime evaluation data of the IM size by means of two-dimensional echocardiography were in a good agreement (r = 0.85) with the morbid anatomy data. Determination of the injury size and ejection was found to be the most informative method for predicting an outcome of acute myocardial infarction. The use of the different combinations of the prognostic signs expands the possibilities of the given method and makes it possible to screen patients with a high risk of a lethal outcome and development of complications on the basis of the primary care at the early disease stage.     

定量组织速度成像技术评价3-AB对急性心肌梗死大鼠左室收缩功能的影响

目的应用定量组织速度成像技术（QTVI）评价3-氨基苯甲酰胺（3-AB）对大鼠急性心肌梗死后左室收缩功能的影响。方法将冠状动脉左前降支起始部结扎的雌性Wistar大鼠随机分为3-AB干预组（n=14）和空白对照组（n=12）。另设同期假手术大鼠（n=10）作为正常对照。3-AB治疗2周后行超声心动图检查。结果与假手术组相比，对照组的左室前壁舒张末期厚度（LVAWd）明显变薄（P〈0．01），左室舒张末期内径（LVDd）、舒张末期容积（EDV）显著增加（P〈0．01）；左室短轴缩短率（FS）、射血分数（LVEF）显著降低（P〈0．01）；心尖四腔左室侧壁及后间隔二尖瓣环、左室长轴观前间隔及后壁中间段收缩期峰值速度显著下降（P〈0．01）；干预组与对照组相比以上各指标均有明显的改善（P〈0．05）。结论定量组织速度成像技术结合常规高频超声心动图能无创定量评价3-AB有效抑制大鼠急性心肌梗死后左室重构及改善左室收缩功能的作用。     

Intracardiac shunting of ruptured Sinus of Valsalva aneurysm in a patient presented with acute myocardial infarction: role of 64-slice MDCT

Rupture of Sinus of Valsalva aneurysm (SVA) may be either congenital or acquired. This report describes a case of intracardiac shunting of a ruptured SVA of atherosclerotic origin to the right atrium, presenting with acute myocardial infarction. The sinus of Valsalva aneurysm and the intracardiac shunt track into the right atrium was not defined by the two-dimensional echocardiography could be seen by 64-slice multi detector computed tomography (MDCT).     

Diagnosis of impairment of segmental myocardial contractility during the acute phase of infarction using sector scanning

The paper is concerned with sector scanning for early diagnosis of acute myocardial infarction. A total of 157 patients were examined within the first 2 to 6 hours after transmural infarction. The segments of the left ventricle which are mostly affected in infarctions of different sites were defined. Application of two-dimensional echocardiography permitted an earlier detecting of the segmental disorders and the extent of the focus of lesion as compared with the ECG. The method appeared particularly informative in the diagnosis of conduction impairment and repeated lesions of the left ventricular myocardium. It has been demonstrated that involvement of over 65% of left ventricular segments is an unfavourable sign from the standpoint of the disease prognosis.     

急诊床旁超声心动图在急重症心血管疾病中应用

目的探讨急诊床旁超声心动图检查在急重症心血管疾病诊断中价值。方法回顾性分析188例行急诊床旁超声心动图检查的急重症心血管疾病患者的临床资料。结果超声心动图诊断与临床诊断相符161例,其中单纯急性心肌梗死14例,非急性心肌梗死后左心功能不全44例,急性心肌梗死合并左心功能不全20例,心包积液47例,慢性肺源性心脏病7例,A型主动脉夹层4例,肺栓塞11例,主动脉瓣狭窄2例,心肌炎2例,肥厚型心肌病6例,风湿性心脏病合并左心房血栓3例,主动脉窦瘤破裂1例,诊断符合率为85．6％。结论急诊床旁超声心动图在急重症心血管疾病的早期诊断中有重要价值。     

Lung cancer mimicking acute myocardial infarction on electrocardiogram

Myocardial involvement by malignant neoplasm is rare and often not clinically manifested. The diagnosis is usually made only at autopsy. A 71-year-old man with squamous cell lung cancer presented with chest discomfort. His electrocardiogram was diagnostic of acute myocardial infarction. However, because of the lack of classic symptoms and signs of acute myocardial infarction and normal serum levels of cardiac enzymes, an echocardiography was performed before initiation of thrombolytic therapy. The echocardiography showed a huge hyperechoic mass located in the posterolateral aspect of the left ventricle with myocardium invasion. Thrombolytic therapy was withheld. In patients with lung cancer, an electrocardiogram representative of acute myocardial infarction can rarely be induced by myocardial involvement with lung cancer.     

Left ventricular mural thrombi secondary to acute myocardial infarction: predisposing factors and embolic phenomenon

Twenty-five patients with acute myocardial infarction were examined for ventricular thrombi using two-dimensional echocardiography. Six of 10 patients (60%) with an anterior wall infarction had an apical or apical-septal thrombus within the first week of hospitalization. None of the fifteen patients with an inferior wall myocardial infarction had a mural thrombus. Although the size of infarction in the patients with a thrombus was not significantly larger than in those who had an anterior wall infarction without a thrombus (43% +/- 10% vs. 31% +/- 7%, P less than 0.1), the severity and extent of dyskinesia or akinesia were more marked in the former group. Left ventricular function as determined by the nuclear blood pool scan ejection fraction was also significantly less for the former group than for the latter group (21% +/- 6% vs. 40% +/- 11%, P less than 0.02). Three of six patients with an intracavitary thrombus on echocardiography had systemic embolic during their hospital course. Postinfarction ventricular thrombi tend to occur in those patients with an anterior wall myocardial infarction who have far advanced wall motion abnormalities of the affected area, and overall poor left ventricular function. Although the number of patients was small, the high incidence of systemic embolization in the infarction subjects with echocardiographically proven thrombi indicates that these patients are at increased risk for such events.     

Cardiac malignant tumor as a rare cause of acute myocardial infarction

Acute myocardial infarction is predominantly caused by coronary artery atherosclerotic plaque rupture and subsequent occlusive thrombus formation. The recognition of less common causes of acute myocardial infarction is important because they may require a different treatment strategy. We report a patient with acute myocardial infarction without any angiographic evidence of coronary atherosclerosis and a left atrial mass detected on echocardiography. Therefore, coronary embolism from intracardiac thrombus or tumor was suspected. No additional manifestations of a potential tumor were found on thoracic, abdominal and cranial computed tomography. During subsequent cardiac surgery, a large tumor could be in toto resected and was diagnosed as a highly malignant leiomyosarcoma on histopathological evaluation.     

Spontaneous delayed recovery of perfusion after thrombolyzed acute myocardial infarction: is it predictable before discharge?

In patients with thrombolyzed acute myocardial infarction, early assessment of the final infarct size is difficult because spontaneous recovery of perfusion and function of the left ventricle may be delayed. This study was undertaken to evaluate the ability of predischarge low-dose dobutamine echocardiography to predict late spontaneous recovery of perfusion assessed by single-photon emission computed tomography after acute myocardial infarction. We prospectively studied 53 consecutive patients with myocardial infarction treated with thrombolysis. Low-dose dobutamine echocardiography and resting (99m)Tc-sestamibi single-photon emission computed tomography (MIBI SPECT) were performed 4 +/- 2 days after infarction. A follow-up SPECT study was carried out in 45 patients after 6 months. Myocardial recovery was defined as a reduction of SPECT defect size by more than 10% at follow-up compared with the early study. In 25 of the 45 patients, the size of the left ventricular perfusion defect decreased significantly from 42% +/- 16% to 27% +/- 10% (group 1), whereas in the remaining 20 patients it showed no significant change (group 2). Predischarge low-dose dobutamine echocardiography showed a significant improvement in wall motion score index compared with baseline in group 1, from 1.62 +/- 0.28 to 1.41 +/- 0.24, P <.001, whereas in group 2 this index remained without significant change. Predischarge low-dose dobutamine echocardiography is an accurate tool for prediction of late recovery of myocardial perfusion after acute myocardial infarction treated with thrombolysis.     

二维应变超声心动图评价大鼠急性心肌梗死模型局部心肌功能改变的应用价值

目的 探讨二维应变超声心动图定量评价大鼠急性心肌梗死模型左室局部心肌功能改变的应用价值.方法 60只Wistar大鼠随机分为两组:实验组50只,制备急性冠状动脉心肌梗死模型;假手术组10只.两组分别于术前及术后1周、4周、8周行超声心动图检查.解剖M型超声心动图测量左室舒张末期及收缩末期内径(LVIDd、LVIDs)、短轴缩短率(FS)、射血分数(EF)和左室质量(LVM).记录左室乳头肌短轴高帧频图像,应用二维应变分析软件测量各节段的收缩期峰值径向应变(PRS)、环向应变(PCS).实验组大鼠检查结束后处死,取出心脏行TTC染色并计算梗死面积;VG染色观察心肌组织中的胶原纤维.结果 根据TTC染色结果将实验组大鼠左窀分为梗死心肌、梗死周围和远处心肌.术后1周VG染色显示实验组大鼠左室各节段均出现不同程度的胶原纤维沉着.与术前及同时期假手术组相比,实验组大鼠于术后1周时梗死心肌、梗死周围及远处心肌的PRS、PCS均明显降低(P<0.01),并持续至第8周.与术后1周时相比,术后4周、8周实验组大鼠梗死心肌、梗死周围及远处心肌的PRS、PCS差异无统计学意义.实验组大鼠于术后4周和8周LVIDd、LVIDs及LVM明显增加,FS明显减低(P<0.05).二维应变测量组间及组内比较均具有高度一致性.结论 二维应变超声心动图可定量评价大鼠心肌梗死模型不同血供区域局部心肌的功能改变,为无创性跟踪心肌梗死后左室重构进程提供了一种敏感可行的方法.     

酷似扩张型心肌病的急性心肌梗死诊断特征并文献复习

目的探讨以心脏扩大为首发表现的急性心肌梗死的临床特点及误诊原因。 方法回顾性分析2020年7月30日济宁医学院附属医院心内科监护室收治的1例急性心肌梗死患者的临床资料，并进行文献复习。 结果患者41岁，男性，入院前10 d受凉后出现咳嗽，咳少量白痰，胸闷逐渐加重，活动耐力降低。心脏超声检查示左心、右房增大，左室整体功能减低，左室射血分数(LVEF)43%，诊断为扩张型心肌病，治疗3 d后患者仍感胸闷不适。入院后复查心脏超声，LVEF降至22%；行心脏磁共振成像检查符合急性心肌梗死磁共振表现；行冠状动脉造影检查发现前降支发出第一对角支后狭窄95%，第一对角支开口近段狭窄80%，于前降支狭窄处植入药物洗脱支架一枚。随访患者心脏超声，心功能恢复良好，出院后8个月LVEF升至56%。 结论心脏磁共振成像检查对不典型急性心肌梗死诊断具有重要意义；血运重建及充分药物治疗可以逆转急性心肌梗死心室重构。     

急诊超声心动评价心脏功能的意义

目的：评价超声心动在急诊心功能不全和急性心肌梗死的意义和可行性，方法：选择急诊以重症心功能不全和第一次急性心肌梗死就诊入住ICU的患者，在就诊即刻至24h内进行超声心动评价心脏左室收缩，舒张功能以及左室局部收缩功能。结果：急诊就诊的心力衰竭的大多数病因是高心病，肺心病和冠心病，分别占41．3％，24．7％，22．2％，单纯舒张性心力衰竭占18％，超声心动可检测急性心肌梗死的左室局部收缩功能异常，但是在溶栓的最佳6h内不能增强诊断及溶栓治疗的信心。结论：急诊超声心动对于急重症心力衰竭和急性心肌梗死的诊治具有重要作用，特别是诊断单纯舒张功能不全具有不可替代的价值，超声心动在急诊科用于心功能和急性心肌梗死的评价也是可行的。     

影像学对体外反搏治疗急性心肌梗塞实验研究的评估价值

目的 实验研究急性心肌梗塞早期(6小时)的影像学变化并评价体外反搏对其的影响。方法 对14头杂种幼猪用闭胸式改良中孔合金珠法造成急性心肌梗塞模型,6小时及7小时分别行DSA血管造影及超声心动图检查,其中7头在6小时时行体外反搏治疗1小时,其余不作任何处理观察1小时,7小时时处死,取病理。结果 1:实验组左心功能(收缩及舒张功能)较对照组明显改善(P<0.01)。2;实验组梗塞变性范围较对照组明显缩小(P<0.01)。3 病理证实龙胆紫染色的心肌区即是心肌梗塞区,表现为典型的缺氧损伤。4:经受损的冠状动脉行DSA造影所显示的心肌染色区的体积与龙胆紫染色的心肌体积相符合,两者无显著性差异(P>0.05)。5:对照组显示典型的缺氧损伤,实验组则明显减轻。结论 DSA造影可以定量显示急性心肌梗塞的范围,心动超声图可测量左心功能的变化,是评价体外反搏治疗急性心肌梗塞的客观依据。     

Takotsubo cardiomyopathy mimicking an acute myocardial infarction

BACKGROUND: Takotsubo cardiomyopathy is characterized by a transient left ventricular dysfunction. The resulting acute symptoms including electrocardiographic changes and elevated myocardial biomarkers often mimic an acute myocardial infarction. However, obstructive coronary artery disease can be excluded by angiography. There is only little information available in the literature. The precise pathophysiology is still unknown. CASE REPORT: The case of a 56-year-old woman with typical manifestation of a highly symptomatic Takotsubo cardiomyopathy is described. The diagnosis was suspected by angiographic absence of obstructive coronary disease. During the following days, Takotsubo cardiomyopathy was confirmed by cardio-MRI and echocardiography. The patient was treated with drugs. 12 days after admission, cardiac function was completely restored. The patient was discharged without showing any symptoms. CONCLUSION: Although takotsubo cardiomyopathy is rather rare, it should be considered as a relevant differential diagnosis mimicking acute myocardial infarction. Despite a generally good prognosis under conservative treatment, complications are reported in 17.7% of all cases in the literature. Therefore, intensive treatment and monitoring are mandatory.