Mean platelet volume is elevated in patients with myocardial infarction with normal coronary arteries,as in patients with myocardial infarction with obstructive coronary artery disease

Abstract

Although the majority of cases of acute myocardial infarction are caused by atherosclerotic coronary artery disease (CAD), it can also occur in people with normal coronary arteries. One of the possible mechanisms causing myocardial infarction with normal coronary arteries (MINC) is transient occlusion of the infarct-related artery owing to platelet hyperactivity and thrombosis. Mean platelet volume (MPV), an indicator of platelet activation, has been shown to be elevated in patients with unstable angina and myocardial infarction in the setting of obstructive CAD. However, the value of MPV in patients with MINC is not known. The aim of this study was to assess the MPV in patients with MINC. We retrospectively studied 47 patients with MINC, 63 patients with myocardial infarction resulting from single coronary artery disease (MISC) and 55 control subjects. MPV values were recorded in all study patients and control subjects. The MPV values of patients with MINC and MISC were significantly higher than those of the control group (9.1±1.8 and 9.4±1.0 versus 8.3±1.4 ?; p<0.05 and p<0.001, respectively). There were no significant differences in MPV values between the MINC and MISC groups. We show for the first time that MPV is significantly higher in patients with MINC compared with control subjects. Concurring with previous studies, we also show that MPV is significantly higher in patients with MISC compared to control subjects.     

延迟经皮冠状动脉介入治疗对急性心肌梗死患者心肌灌注及心功能的影响

目的：采用99 m 锝甲氧基异丁基异腈(99 m Tc-MIBI)门控静息心肌断层显像,研究延迟经皮冠状动脉介入(percutaneous coronary intervention,PCI)对急性心肌梗死(acute myocardial infarction,AMI)的疗效。方法选首次发病时间超过12小时但不超过72小时,未行溶栓治疗且无持续胸痛的 AMI 患者62例,随机分为对照组(n =31),只给予常规药物治疗,延迟 PCI 组(n =31)在常规药物基础上,发病后7~14天行 PCI 治疗。两组均于发病1周及治疗后4周行99 m Tc-MIBI 门控静息心肌断层显像,比较两组治疗前后左心室舒张末期容积(left ventricular end diastolic volume,LVEDV),左心室收缩末期容积(left ventricular end systolic volume,LVESV)、左心室射血分数(left ventricular ejection fraction,LVEF)、心肌缺血面积(ischemic area,IA)的变化。结果两组患者发病1周时的LVEDV、LVESV、LVEF 及 IA 差异无统计学意义。治疗4周后延迟 PCI 组 LVEDV、LVESV 明显下降,分别为(73.87±5.90)ml vs (81.20±7.14)ml,(26.51±3.51)ml vs (30.90±3.84)ml(P <0.01);与对照组比较 LVEF明显升高,(66.23±5.20)% vs (60.97±4.58)%(P <0.01)、IA 明显缩小(10.67±3.01)% vs (12.93±3.54)%(P <0.01)。结论对于 AMI 患者,延迟 PCI 可以更完全地血运重建,明显改善心肌灌注及恢复心室功能,可以改善预后;99m Tc-MIBI 门控静息心肌断层显像可以定量分析心肌灌注及心功能变化,可以准确评价延迟 PCI 治疗 AMI 效果。     

无创心肌做功评估经皮冠状动脉介入治疗后急性ST段抬高型心肌梗死患者心肌节段微血管灌注

目的 观察无创心肌做功（MW）评估经皮冠状动脉介入治疗（PCI）后急性ST段抬高型心肌梗死（STEMI）患者心肌节段微血管灌注（MVP）的效能。方法 分析119例经PCI治疗的STEMI患者术后72 h内超声心动图及心肌超声造影（MCE）检查资料,评估心肌节段MVP水平,对比不同水平MVP心肌节段的纵向应变（LS）和心肌有用功（CMW）、无用功（WW）、MW指数（MWI）及MW率（MWE）;以多因素logistic回归分析观察MVP减低的独立影响因素,以受试者工作特征（ROC）曲线分析其评估MVP减低的效能。结果 共纳入2 142个心肌节段,其中MVP正常组1 515个节段（造影剂恢复充盈时间≤4 s）,延迟组321个节段（造影剂恢复充盈时间>4 s且<10 s）,减低组306个节段（造影剂恢复充盈时间≥10 s）;3组间心肌节段LS、CMW、WW、MWI和MWE总体及两两比较差异均有统计学意义（P均<0.001）。将MVP正常及延迟者归为MVP未减低组,其与减低组间心肌节段LS、CMW、WW、MWI及MWE差异均有统计学意义（P均<0.001）。MWI[OR=1.00,95%CI（1.00,1.00）,P=0.023]、MWE[OR=0.98,95%CI（0.97,1.00）,P=0.010]、CMW[OR=1.00,95%CI（1.00,1.00）,P<0.001]均为MVP减低的独立影响因素,其评估MVP减低的曲线下面积（AUC）分别为0.856、0.853及0.877,CMW大于MWI、MWE （Z=5.246、2.307,P均<0.05）。结论 无创MW可有效评估PCI后STEMI患者心肌节段MVP。     

急性心肌梗死冠状动脉介入术后心肌微循环灌注障碍的影响因素及与乳酸关系

目的 探讨急性心肌梗死冠状动脉介入手术后心肌微循环灌注障碍的影响因素及与乳酸关系.方法 选取2019年2月至2020年7月我院收治的急性心肌梗死冠状动脉介入手术患者132例,根据术后TIMI心肌组织灌注分级(TMPG)分为两组,即观察组56例,TMPG 0～2级,心肌微循环灌注不良;对照组76例,TMPG 3级,心肌微...     

替罗非班对急性心肌梗死患者介入术后心肌灌注和血小板活化功能的影响

目的 探讨替罗非班对急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后心肌灌注和血小板活化功能的影响.方法 80例AMI患者按随机数字表法分为2组,均于发病12 h内行急诊PCI术.对照组40例采用常规抗凝治疗(阿司匹林+低分子肝素+氯吡格雷).替罗非班组40例在对照组治疗的基础上于PCI术中冠状动脉内注入盐酸替罗非班10μg/kg,静脉维持量0.15 μg/(kg·min)36 h.观察2组PCI术后15 min梗死相关血管心肌灌注分级(TMPG)、治疗前及治疗7 d后血小板活化功能的变化、术后30 d内出血并发症及主要不良心脏事件(MACE)的发生情况.结果 替罗非班组PCI术后15 min TMPG灌注3级的百分比显著高于对照组[97.5%(39/40)与80.0%(32/40),x2=4.507,P＜0.05];治疗7 d后,替罗非班组的血小板活化指标血小板α颗粒表面膜糖蛋白、溶酶体膜糖蛋白、单核细胞血小板聚集体的阳性表达率显著低于治疗前和对照组[替罗非班组治疗后:(1.7±0.7)%、(1.5±0.7)%、(11.7±3.8)%,治疗前:(7.2±2.5)%、(6.9±1.8)%、(22.0±7.8)%,t值分别为13.398、17.683、7.508;对照组治疗后:(2.9±1.2)%、(3.9±0.6)%、(16.2±4.2)%,t值分别为5.463、16.468、5.025,P均＜0.01];治疗30 d后,替罗非班组心血管事件发生率显著低于对照组(0%与15.0%(12/40),x2=4.504,P＜0.05);2组出血并发症发生率比较差异无统计学意义(10.0%(4/40)与5.0%(2/40),x2=0.180,P＞0.05).结论 在AMI介入治疗中,应用盐酸替罗非班能改善心肌灌注,进一步抑制血小板的活化功能,减少PCI术后主要不良心脏事件的发生率,且不增加严重出血的发生.

Abstract：

Objective To evaluate the influence of tirofiban on myocardial perfusion through percutaneous coronary intervention (PCI) and platelet activation in patients with acute myocardial infarction (AMI). Methods Eighty patients with acute myocardial infarction who underwent emergency PCI within 12 hours were randomly divided into 2 groups due to the random number table method: tirofiban group (40 patients) and control group (40 patients). The control group received conventional anticoagulant therapy (aspirin + low molecular weight heparin + clopidogrel). The tirofiban group additionally received intracoronary tirofiban hydrochloride injection of 10 μg/kg PCI during PCI, intravenous maintenance dose of 0. 15 after PCI 15 mins, the changes of platelet activation before and after treatment 7 days,the bleeding complications and major adverse cardiac events (MACE) within 30 days after PCI. Results The TMPG 3 perfusion percentage of tirofiban group (97.5% ,39/40) after PCI 15 minutes was significantly higher than that (80. 0%,32/40) of the control group( x2 = 4. 507,P ＜ 0. 05 ) ;The expression positive rate of platelet activation CD62P,CD63, MPA of the tirofiban group after treatment of 7 days were ( 1.7 ± 0. 7 ) %, ( 1.5 ± 0. 7 ) % and ( 11.7 ±3.8)% ,respectively,which were significantly lower than those of before treatment ([7.2 ± 2. 5]%, [6. 9 ±1.8]% and [22. 0 ± 7. 8] %, respectivley) and those of the control group after treatment of 7 days ( [2. 9 ±1.2]% ,[3.9 ±0.6]% and [16.2 ±4.2]% ,respectivley)(t =5.463,16. 468 and 5.025, Ps ＜0.01 );The incidence of cardiovascular events of the tirofiban group (0) was significantly lower than that of the control group ( 15.0%, 12/40 ) after treatment of 30 days ( x2 = 4. 504, P ＜ 0. 05 ); The incidence of bleeding complications was not significant between the 2 groups ( x2 = 0. 180, P ＞ 0. 05 ). Conclusion The application of tirofiban hydrochloride in intervention in acute myocardial infarction can improve myocardial perfusion, and further inhibiting platelet activation and reduce the incidence of major adverse cardiac events after PCI while does not increase the incidence of severe bleeding.     

Myocardial perfusion scintigraphy (SPECT) during adenosine stress can be performed safely early on after thrombolytic therapy in acute myocardial infarction

The objective of this study was to evaluate the safety of myocardial perfusion scintigraphy with Tc-99 m sestamibi during adenosine stress in patients with recent thrombolytically treated myocardial infarction. Eighty-four patients with thrombolytically treated myocardial infarction, 59 males and 25 females, aged 62·9 ± 8·4, were eligible for myocardial perfusion scintigraphy during adenosine provocation. Exclusion criteria for adenosine stress were hypotension, unstable angina pectoris, cardiac failure, pericarditis and atrioventricular block (AV block) II–III. Adenosine-stress and resting myocardial perfusion scintigraphy was performed 2–5 days after thrombolysis. Scintigraphy at rest was done 24 h after the stress study. Sixty patients (71%) experienced some kind of side-effects during adenosine infusion. The most frequent side-effects were dyspnoea in 43/84 patients (51%) and unspecific chest discomfort in 26/84 patients (31%). During infusion, ST depressions or elevations on ECG were seen in 9 patients (11%), 5 of whom experienced atypical chest discomfort. Five patients (6%) described typical angina but none of them showed electrographic signs of myocardial ischaemia during infusion. Six patients (7%) developed transient AV block I–II. Reversible scintigraphic perfusion defects were seen in 67 patients (79%). No serious complications, such as death, reinfarction or severe arrhythmias, occurred during adenosine infusion or during a 3-day clinical follow-up period. In conclusion, MIBI-SPECT during adenosine stress is a safe diagnostic method that can be performed in most patients early on after thrombolytically treated acute myocardial infarction. Side-effects are common but benign, and not different from those seen in patients with chronic coronary artery disease.     

Myocardial infarction with non obstructive coronary arteries (MINOCA): a whole new ball game

Introduction: MINOCA is a clinical syndrome that encompasses a subgroup of heterogeneous patients who present with myocardial infarction yet do not have any significant coronary artery obstruction on angiogram. As many as one in ten patients with acute myocardial infarction (AMI) will not have an occluded coronary artery, and the reported prevalence keeps rising, in part due to better recognition of this syndrome. Current guidelines offer several diagnostic algorithms but MINOCA remains largely under-recognised and little is known about whether patients might benefit from a more specific treatment modality.

Areas covered: We review pathogenesis, diagnosis, prognosis, and management of MINOCA.

Expert commentary: Due to the significant heterogeneity of MINOCA patients, a more efficient management strategy may solely rely on an individualized approach in order to improve outcomes.     

Presentation and outcome of myocardial infarction with non-obstructive coronary arteries in coronavirus disease 2019

Among the cardiac complications of coronavirus disease 2019 (COVID-19), one increasingly reported in the literature is myocardial infarction with non-obstructive coronaries (MINOCA). We reviewed all reported cases of MINOCA in COVID-19 patients to summarize its clinical features, evaluation, and treatment. We performed a literature search in Pubmed using the search terms ‘COVID-19’ and ‘MINOCA’ or ‘non-obstructive coronaries’. Among the reported cases, the mean age was 61.5 years (SD ± 13.4), and 50% were men. Chest pain was the presenting symptom in five patients (62.5%), and hypertension was the most common comorbidity (62.5%). ST-elevation was seen in most patients (87.5%), and the overall mortality rate was 37.5%. MINOCA in COVID-19 is an entity with a broad differential diagnosis. Therefore, a uniform algorithm is needed in its evaluation to ensure timely diagnosis and management.     

High prevalence of tetrofosmin reverse redistribution pattern in patients with myocardial infarction and angiographically smooth coronary arteries. Published in voL 18/1, pp. 31-40

Editorial Commentary

High prevalence of tetrofosmin reverse redistribution pattern in patients with myocardial infarction and angiographically smooth coronary arteries. Published in Vol. 18/1, pp.31–40     

应激性高血糖与老年急诊冠状动脉介入术后心肌灌注及临床预后的相关性

目的分析应激性高血糖（SHG）对行急诊经皮冠状动脉介入术（PCI）老年患者心肌灌注情况影响及与预后的相关性。方法选择首次急性ST段抬高心肌梗死（STEMI）且于12 小时内成功实施急诊PCI老年非糖尿病患者459例,依据入院即刻血糖值分为正常组（血糖＜7.0 mmol/L,148例）、升高组（7.0 mmol/L≤血糖≤11.1 mmol/L,169例）、高糖组（血糖＞11.1 mmol/L,142例）。对比各组术后心功能指标、心肌灌注情况,术后随访12个月,记录各组不良心脏事件（MACE）情况。结果正常组、升高组、高糖组心肌灌注血流分级（TMPG） 2～3级的比例、术后2 小时ST段回落良好的比例及左心室射血分数均逐渐下降,而肌酸激酶同工酶的峰值逐渐升高（均P＜0.05）。随访12个月,高糖组无MACE的生存率76.1％（108/142）,较正常组89.2％（132/148）、升高组85.8％（145/169）降低,差异有统计学意义（P＜0.05）;经多因素Cox回归分析提示,SHG也是老年STEMI患者PCI术后发生MACE的一个独立预测因素。结论SHG可导致老年STEMI患者行急诊PCI后心肌灌注下降,同时也可使MACE的发生率增高。     

Impact of low triiodothyronine syndrome on long-term outcomes in patients with myocardial infarction with nonobstructive coronary arteries

BackgroundLow triiodothyronine syndrome (LT3S), frequently seen in patients with acute myocardial infarction (AMI), has been regarded as a predictor of poor outcomes after AMI. However, little is known about the prognostic value of LT3S in euthyroid patients with myocardial infarction with nonobstructive coronary arteries (MINOCA).MethodsA total of 1162 MINOCA patients were enrolled and divided into LT3S and no-LT3S groups. LT3S was defined as decreased free T3 (fT3 < 2.36 pg/mL) with normal values of thyroid-stimulating hormone. The primary endpoint was a composite of major adverse cardiovascular events (MACE), including all-cause death, nonfatal MI, stroke, revascularization, and hospitalization for unstable angina or heart failure. Kaplan–Meier, Cox regression, propensity score matching (PSM), and receiver-operating characteristic analyses were performed.ResultsPatients with LT3S (prevalence of 17.5%) had a significantly higher incidence of MACE (19.6% vs. 12.9%; p = .013) than patients without during the median follow-up of 41.7 months. LT3S was closely associated with an increased risk of MACE even after multivariable adjustment (HR 1.50, 95% CI: 1.03–2.18, p = .037). After PSM, 197 pairs of patients with or without LT3S were identified, and LT3S remained a robust risk factor of worse outcomes (HR 1.53, 95% CI: 1.02–2.65, p = .042). Moreover, LT3S had an area under the curve (AUC) of 0.60 for predicting MACE. When adding LT3S to the thrombolysis in myocardial infarction (TIMI) risk score, the combined model yielded a significant improvement in discrimination for MACE.ConclusionsLT3S was independently associated with poor outcomes after MINOCA. Routine assessment of LT3S may provide valuable prognostic information in this specific population.     

双血管急性闭塞的急性ST抬高型心肌梗死的冠状动脉间血流灌注影响

目的 探讨双支冠状动脉急性闭塞致急性ST段抬高型心肌梗死(STEMI)的冠状动脉间的血流灌注影响及形成原因.方法 回顾性分析2013年2月至2014年2月在北京中日友好医院心内科连续行急诊直接经皮冠状动脉介入治疗的双支冠状动脉闭塞导致STEM1的15例患者,分析其临床资料、急诊冠脉造影、手术情况及复查的冠脉造影情况.对比TIMI前向血流比较各冠脉血管血流灌注情况.结果 15例STEMI患者,急性前壁下壁心肌梗死8例,急性下壁后壁心肌梗死5例,急性前壁侧壁心肌梗死2例,伴心源性休克早期表现者达14例;急诊手术采取一次性或分阶段治疗两种治疗策略.术后经冠心病监护病房继续治疗,患者全部存活.术后入选患者进行冠状动脉造影复查发现,所有入选患者在急诊手术中未开通的6支闭塞血管,自行再通其前向血流都在TIMI 2级以上.结论 双支冠脉急性闭塞的STEMI是临床罕见病例,可能存在冠状动脉先发罪犯血管闭塞同时诱发另一支冠状动脉急性病变而出现双支血管急性闭塞的形式,心源性休克可能参与该病理生理过程;并且STEMI合并心源性休克进行一次性治疗策有临床实践价值.     

早期新型心脏康复模式对急性心肌梗死PCI术后患者心肌血流灌注及心肺功能的影响

目的探讨早期新型心脏康复模式对急性心肌梗死经皮冠状动脉介入(PCI)术后患者的干预效果。方法选取2018年1月至2020年1月收治的80例急性心肌梗死PCI手术患者,将其随机分为对照组和观察组,各40例。对照组采用常规心脏康复模式干预,观察组采用早期新型心脏康复模式干预。比较两组的心肌血流灌注、心肺功能指标及生活质量评分。结果干预后,观察组的TIMI血流分级优于对照组(P<0.05)。干预后,两组的CO、LVEF均较干预前升高,PAP均较干预前降低,且观察组优于对照组(P<0.05)。干预后,两组患者的SF-36各维度评分均较干预前升高,且观察组高于对照组(P<0.05)。结论给予急性心肌梗死PCI术后患者早期新型心脏康复模式,有助于促进心肌血流灌注及心肺功能改善,提高生活质量,值得临床推广应用。     

Relationship between exercise-induced ST segmental depression and myocardial ischemia assessed by technetium-99m tetrofosmin SPECT imaging in patients with inferior Q wave myocardial infarction

Background: ST segment depression (STD) is a standard electrocardiographic sign of myocardial ischemia. Although STD may represent reciprocal changes in patients with previous myocardial infarction, studies of reciprocal changes during exercise testing are scarce. Methods: From December 1999 to December 2000, 160 patients (119 males, 41 females, mean age 54 ± 8 years), undergoing maximal or symptom-limited exercise treadmill test (Bruce-protocol), myocardial perfusion scintigraphy using technetium-99m tetrofosmin single photon emission computed tomography (SPECT) imaging, within 30 days of an uncomplicated inferior Q wave myocardial infarction. The location of STD at the electrocardiogram (ECG) was defined as anterior (V1-4), high lateral (I, aVL), and lateral (V5-6). Ischemia was defined as reversible perfusion abnormalities. Results: STD occurred in anterior leads in 29 patients (18.1%), in the lateral leads in 41 patients (25.6%), in the high lateral leads in 20 patients (12.5%). In 70 patients (43.8%) no significant STD occurred during the exercise test. ST segment elevation occurred in 28 patients (17.5%) in inferior leads. High lateral STD was associated with inferior ST elevation in 16 patients (80%), whereas only eight patients (19.5%) with lateral STD and nine patients (31%) with anterior STD were associated with inferior ST elevation. Ischemia was detected in 63 of 90 patients (70%) with and in 10 of 70 patients (14.3%) without STD (p < 0.0001). Patients with high lateral STD had a higher prevalence of fixed perfusion defects in the inferior wall (95 vs. 27.8%) and in posterolateral wall (75 vs. 18.9%) compared with other patients (p = 0.003 and 0.002, respectively). Ischemia was more prevalent in patients with lateral STD than without ( 87.8 vs. 14.3%, p < 0.0001). Conclusion: In patients with inferior Q wave, the presence of exercise-induced STD in lateral and anterior leads appears to be a sign of myocardial ischemia, and may require invasive evaluation; on the other hand, the presence of STD in high lateral leads should be recognized as a reciprocal change for ST elevation in the inferior leads, and may not be an indication for invasive evaluation.     

急诊经皮冠状动脉腔内成形术治疗老年人急性心肌梗死

目的 :探讨老年人急性心肌梗死 (AMI)急诊经皮冠状动脉腔内成形术的成功率及近期预后。方法 :对 1994年以来收治的 6 3例 (男 5 2例 ,女 11例 ,年龄 6 0～ 76岁 )老年人AMI进行了急诊PTCA ,其中直接PTCA 42例 ,补救性PTCA 2 1例 ,观察手术前后患者梗塞相关动脉 (IRA)狭窄程度、TIMI血流、近期存活率及部分患者心功能状况。结果 :6 3例老年人AMI经冠状动脉造影发现IRA 70段 ,急诊PTCA后完全再通 6 6段 ,成功率 94 3% ,3例中的 4段IRA未获成功。术后残余狭窄 (0 %～ 2 0 % )较术前狭窄 (95 %～ 10 0 % )程度明显改善 (P <0 0 0 1) ,均恢复TIMI 3级血流。除 2例于住院期间死亡 (占 3 2 % )外 ,其余患者全部存活 ,9例合并低血压状态或心源性休克及 10例合并心功能不全 (NYHAⅡ～Ⅲ级 )患者术后临床症状改善。术后 3个月左右无再梗死及猝死发生。结论 :急诊PTCA治疗老年人AMI成功率高 ,住院病死率低 ,近期预后良好 ,故是老年人AMI有效的治疗手段     

Assessment of 99mTc-sestamibi myocardial redistribution following acute myocardial infarction and revascularization

Revascularization with primary percutaneous coronary intervention for ST segment elevation myocardial infarction results in restored epicardial flow in the majority of patients. However, in more than 25% of patients, flow does not translate into tissue perfusion. To assess revascularization success, it is necessary to evaluate beyond epicardial flow and to address tissue perfusion. 99mTc-sestamibi single photon emission computed tomography (SPECT) might be useful in this setting, but whether sestamibi redistributes when administered during reperfusion has been debated. The aim of this study was to investigate whether clinically significant redistribution could be detected in a porcine model mimicking acute myocardial infarction and revascularization. Ten pigs were studied in a closed-chest model of myocardial infarction. 99mTc-sestamibi was administered during reperfusion, and SPECT was performed every 30 min for 4 h. The quantitative program CEQUAL was used for analysis and perfusion defects were reported in percentage. All animals had eight acquisitions. The size of the perfusion defect in the individual animals ranged from (mean +/- SD) 13 +/- 3 to 34 +/- 2%. The difference between the first and the last perfusion defect in a single animal was (mean +/- SD) 2.5 +/- 5.3%, which is not statistically significant (P = 0.17). The slopes of regression lines obtained from plots of the individual values ranged from -1.39 to 0.76 with a mean of -0.23 +/- 0.68, which is not statistically significant (P = 0.31). In conclusion, we found no sign of sestamibi redistribution in this experimental set-up of reperfused myocardial infarction. If these findings can be extrapolated to clinical practice, then it means that acquisition can be performed at any time within the first 4 h after tracer injection without significant difference in perfusion assessment.     

老年急诊冠状动脉介入术后心肌灌注的影响因素

目的研究并探讨老年ST段抬高型心肌梗死(STEMI)患者行急诊冠状动脉介入术(PCI)后心肌灌注的相关影响因素。方法选取本院就诊的168例STEMI患者作为研究对象,根据造影灌注积分(APS)将患者分为完全灌注(CMP)组、部分灌注(PMP)组以及无灌注(NMP)组,其中CMP组54例,PMP组96例,NMP组18例,比较3组的一般资料、冠状动脉造影以及PCI结果,通过Logistic多因素回归分析判定患者行急诊PCI后心肌灌注的影响因素。结果对患者一般资料进行比较发现,3组患者在入院时血糖、Killip分级、梗死前心肌绞痛发生率、发病及球囊开通时间、肌酸激酶同工酶(CK-MB)峰值以及肌酸激酶(CK)峰值等方面差异显著(P0.05);此外,3组患者的高血栓负荷率也存在显著差异(P0.05);Logistic多因素回归分析显示,静脉应用替罗非班、梗死前心绞痛、入院时血糖、高血栓负荷以及发病至球囊开通时间是患者行急诊PCI后心肌灌注的影响因素(P0.05)。结论入院时血糖、静脉应用替罗非班、梗死前心绞痛、高血栓负荷以及发病至球囊开通时间等均是老年STEMI患者行急诊PCI后心肌灌注程度的影响因素。     

Assessment of resting perfusion defects in patients with acute myocardial infarction: comparison of myocardial contrast echocardiography, combined first-pass/delayed contrast-enhanced magnetic resonance imaging and 99mTC-sestamibi SPECT

Background Information on the accuracy of both magnetic resonance imaging (MRI) and myocardial contrast echocardiography (MCE) for the identification of perfusion defects in patients with acute myocardial infarction is limited. We evaluated the accuracy of MRI and MCE, using Single Photon Emission Computed Tomography (SPECT) imaging as reference technique.Methods Fourteen consecutive patients underwent MCE, MRI and ^99mTc-MIBI SPECT after acute myocardial infarction to assess myocardial perfusion. MCE was performed by Harmonic Power Angio Mode, with end-systolic triggering 1:4, using i.v. injection of Levovist^®. First-pass and delayed enhancement MRI was obtained after i.v administration of Gadolinium-DTPA. At MCE, homogeneous perfusion was considered as normal and absent or “patchy” perfusion as abnormal. At MRI, homogenous contrast enhancement was defined as normal whereas hypoenhancement at first-pass followed by hyperenhancement or persisting hypoenhancement in delayed images was defined as abnormal.Results At MCE 153 (68%) of segments were suitable for analysis compared to 220 (98%) segments at MRI (p<0.001). Sensitivity, specificity and accuracy of MCE for segmental perfusion defects in these 153 segments were 83, 73 and 77%, respectively. Sensitivity, specificity and accuracy of MRI were 63, 82, and 77%, respectively. MCE and MRI showed a moderate agreement with SPECT (k: 0.52 and 0.46, respectively). The agreement between MCE and MRI was better (k: 0.67) that the one of each technique with SPECT.Conclusion MCE and MRI may be clinically useful in the assessment of perfusion defects in patients with acute myocardial infarction, even thought MCE imaging may be difficult to obtain in a considerable proportion of segments when the Intermittent Harmonic Angio Mode is used.     

前壁合并下壁心肌梗死的临床特点及罪犯血管

目的探讨前壁合并下壁心肌梗死的临床特点及其与冠状动脉造影结果的关系。方法对22例前壁合并下壁心肌梗死患者进行回顾性研究分析。结果本组患者22例,男21例,女1例。合并高血压病、高脂血症及糖尿病分别为72.7%、31.8%和18.2%。有吸烟史占22.7%。典型胸痛、不典型胸痛及无胸痛分别为54.5%、22.7%和22.7%。胸片、心脏超声、心电图及肾功能异常分别为72.7%、100%、100%和18.2%。冠状动脉造影显示:冠脉为右优势分布14例,占63.6%,左优势分布3例,占13.6%;均衡型分布5例,占22.7%。病变累及冠脉66支共76处,单支病变22.7%、二支病变27.3%、多支病变50.0%,受累的前降支(LAD)、右冠状动脉(RCA)、左回旋支(LCX)及左主干(LM)分别为100%、54.5%、72.7%和9.1%。A型病变累及冠脉17支22处(25.8%)、B型病变累及冠脉26支30处(39.4%)、C型病变累及冠脉23支24处(34.8%),重度以上狭窄占80.3%。16例(72.7%)有不同程度的侧支循环。3例AAMI+AIMI中,2例罪犯血管为单支病变,均为LAD,1例为多支病变,累及LAD、LCX及RCA。结论前壁合并下壁心肌梗死患者,多合并危险因素,临床表现复杂,临床检查多有异常,冠脉分布以右优势型居多,冠脉病变以二支及多支病变为主,B型及C型病变占大多数、冠脉狭窄程度较严重,多数患者有不同程度的侧支循环。AAMI+AIMI中,罪犯血管多为LAD,且预后良好。