急性前壁心梗T波倒置程度的临床观察

目的探讨急性前壁心肌梗死（AMI）早期最大倒置T波（NTmax）的临床意义。方法以52例初发前壁AMI12h内来院就诊者作为观察对象。根据倒置T波深度分为2组：①A组深倒置T波组：NTmax〉6mm;②B组浅倒置T波组：NTmax≤6mm。根据患者临床表现、肌酸激酶最高值（CKmax）、心脏超声左室射血分数（LVEF）、冠状动脉造影TIMI血流和心肌同位素显像,判断心肌梗死严重程度和左室功能状况及治疗效果。结果NTmax与CKmax和心肌显像缺血程度呈负相关,与TMI血流和左室射血分数呈正相关。A组较B组,降低的R波迅速恢复,抬高的ST段恢复得早,T波早期倒置且恢复快,住院心血管事件并发症少。结论最大倒置T波NTmax在临床上可作为判断前壁AMI严重程度和治疗效果的一种简便指标。     

急性心肌梗死溶栓治疗早期T波改变临床价值的探讨

目的探讨急性心肌梗死(AMI)患者溶栓治疗早期T波改变的临床意义。方法AMI溶栓治疗患者63例,T波早期倒置患者(A组)33例,非T波早期倒置患者(B组)30例;比较两组间肌酸激酶(CK)峰值、出现时间及左室射血分数(LVEF)。结果2组间CK峰值、出现时间及左室射血分数(LVEF)有显著性差异。结论溶栓后早期T波倒置的患者,冠状动脉开通更充分;其可作为评估溶栓成功及预后的指标。     

急性心肌梗死后T波极性变化与左心功能的关系

目的探讨Q波性心肌梗死从急性期到慢性期心肌损害、心功能与T波方向变化的关系.方法选择急性前壁心肌梗死病人93例,持续T波倒置组44例,T波直立组49例,按T波恢复直立的时间不同又分4个亚组:＜3月组6例;(3～6)月组16例;(6～12)月组23例;持续直立组4例.测量各组的左室射血分数、舒张末径、室壁运动记分等超声心动图指标.结果除持续T波直立亚组外,其他T波直立亚组的左室射血分数高于T波倒置组,左室舒张末径、室壁运动记分低于T波倒置组.结论早期T波由倒置变为直立的病人,左心功能改善显著;有Q波的导联倒置T波正常化的早晚可以用来评估左心功能.     

急性前壁心肌梗死患者早期T波倒置对PCI策略的影响

目的 观察急性前壁心肌梗死(AAMI)早期出现T波倒置患者梗死相关动脉(IRA)血流灌注情况,探讨不同心电图T波表现的心肌梗死患者行延迟PCI的价值.方法 选择初发前壁心肌梗死患者69例,均未行直接PCI治疗.根据病发后48 h内心电图有无T波出现倒置分为倒置组和未倒置组.行超声心动图检查,记录反映心功能的几项参数:左室射血分数(LVEF),左室舒张末期内径(LVEDD),室壁运动积分(WMI)等指标.于病发后的10～14 d进行冠状动脉造影,观察梗死相关动脉血流灌注情况,并酌情进行介入治疗.术后12个月时再次进行超声检查,观测以上心功能指标,进行术前术后的纵向比较以及配对组之间的横向比较,分析延迟介入治疗的效果.结果 T波倒置组的IRA血流达TIMI2～3级者明显高于未倒置组;12个月时,T波倒置组的LVEF高于未倒置组,LVEDD、WMI低于未倒置组.结论 心肌梗死后早期出现T波倒置是血管再通的间接指标.对于未行直接PCI治疗的早期T波倒置的急性心肌梗死患者,进行延迟PCI实现血管重建的治疗意义大于完全闭塞者.     

扩心病患者T波电交替与心功能的关系

目的研究扩张型心肌病患者T波电交替(T-wave alternans,TWA)的发生与左室大小、射血分数等心功能状况的关系。方法 31例扩张型心肌病患者,男30例,女1例,年龄50.06±7.14(40~61)岁。对所有患者用Cambridge Heart.Heartwave TM system心脏诊断系统,以频谱法检测MTWA(Microvolt T-wave alternans,微伏级T波电交替)。对所有患者进行体检、超声心动图等检查。超声心动图测量左室舒张末内径(LVEDD)、左室射血分数(LVEF)等。分析MTWA的发生与左室大小、左室射血分数等的关系。结果扩张型心肌病MTWA阳性组的左室舒张末径大于MTWA阴性组(p0.01),左室射血分数低于MTWA阴性组(p0.01)。扩张型心肌病LVEDD≥65mm组MTWA阳性率高于LVEDD65mm组(p0.01),LVEF≤40%组MTWA阳性率高于LVEF40%组(p0.01)。结论扩张型心肌病患者MTWA阳性者左室末径大于阴性者,射血分数低于阴性者;左室舒张末径大(≥65mm)和/或射血分数低(≤40%)的扩张型心肌病患者MTWA阳性率高,支持TWA是一项新的判断预后指标,值得临床进一步研究。     

急性心肌梗死后存活心肌对梗死相关血管晚期血运重建术后左室功能的影响

目的探讨存活心肌对急性心肌梗死(AMI)后梗死相关血管(IRA)晚期血运重建术后远期左室功能以及左室重构的影响.方法69例AMI未接受早期再灌注治疗者,于发病10～21 d行IRA经皮冠状动脉血运重建(PCI)术,术前于AMI发病后5～10 d应用小剂量多巴酚丁胺(5和10μg·min-1·kg-1)超声心动图负荷试验检测存活心肌,并分别测定和计算给药前后左室腔大小、左室射血分数(LVEF)以及室壁运动积分(WMS).按有无存活心肌分为存活心肌组和无存活心肌组,超声心动图随访术后6个月时两组左室腔大小、LVEF和WMS的变化.结果157个运动异常节段中89个节段(57%)有存活心肌,有存活心肌组26例(占38%),无存活心肌组43例(占62%).存活心肌组术后6个月LVEF较术前明显提高(P＜0.05),收缩末期容积指数(LVESVI)和WMS明显降低(P＜0.05和P＜0.01);而无存活心肌组LVEF较术前明显降低(P＜0.01),LVESVI和左室舒张末期容积指数(LVEDVI)较术前明显增加(P＜0.05),WMS无明显变化.存活心肌组多巴酚丁胺负荷时的LVEF和WMS明显改善,且与6个月时的测定值相近;而无存活心肌组PCI前应用多巴酚丁胺LVEF和WMS均无明显变化.结论AMI后有存活心肌者晚期血运重建有利于改善远期左室功能和减少左室重构.心肌梗死后早期小剂量多巴酚丁胺负荷状态下左室收缩功能的提高预示晚期血运重建术后心功能改善.     

老年冠心病合并高血压及2型糖尿病患者核素心肌显像与血清学指标研究

目的 应用99m锝-甲氧基异丁基异腈(99mTc-MIBI)单光子发射计算机断层(SPECT)心肌灌注显像对比分析老年冠心病患者(CHD)与CHD合并2型糖尿病(T2DM)和/或原发性高血压(EH)患者心肌缺血、心功能差异,并比较各组间血清学指标差异.方法 对237例老年CHD患者行门控SPECT核素心肌灌注显像,按病情分为4组:单纯CHD组、合并T2DM组、合并EH组、合并T2DM及EH组.分别统计4组总负荷评分(SSS)、总静息评分(SRS)、和总差值(SDS)、左室射血分数(LVEF)及血清学各项指标,并对4组数据进行对比分析.结果 合并T2DM组、合并EH组、合并T2DM及EH组核素心肌灌注显像SSS、SDS及D-二聚体(D-D)、血管性假血友病因子(vWF)、超敏C-反应蛋白(hs-CRP)均高于单纯CHD组(P＜0.05),而LVEF明显小于单纯CHD组(P＜0.05);合并T2DM及EH组SSS、SDS及D-D、vWF、hs-CRP均高于单纯合并T2DM组或合并EH组,左室射血分数(LVEF)则明显降低(P＜0.05);合并T2DM组、合并EH组两组间无明显差异(P=0.34);4组间血脂无明显差异.多因素分析显示D-D、vWF、hs-CRP水平与SSS、SDS呈正相关.结论 核素心肌灌注显像可有效评价冠脉心肌血供情况;CHD合并T2DM或EH患者心肌缺血显著,心功能较差;合并T2DM及EH患者心肌缺血最严重,而且心功能最差;D-D、vWF、hs-CRP水平可反映心肌缺血程度.     

血清CA125水平与急性心肌梗死关系初探

目的 观察急性心肌梗死患者血清糖类抗原125(CA125)水平的变化及其临床意义.方法 心肌梗死组80例,在入院后第3天检查彩色多普勒超声心动图,测左室舒张末期内径(INEDD)、左室射血分数(LVEF)、舒张早期和晚期最大血流速度比(E/A)、平均肺动脉压(mPAP),根据LVEF分A组(LVEF＞0.50,36例)和B组(LNEF≤0.50,44例),抽血检测心肌型肌酸磷酸激酶同功酶(CKMB)、肌钙蛋白T(TnT)的峰值浓度,并在人院后72 h测血清CA125水平.对照组50例,既往无器质性心脏病史和异常心脏彩超改变.排除引起CKMB、TnT、CA125升高的其他因素.结果 心肌梗死组和对照组LVEF、E/A、mPAP、CA125、CKMB、TnT差异有统计学意义(P＜0.05);A组和B组LVEF、E/A、mPAP、CA125差异有统计学意义(P＜0.05);CA125与LVEF、E/A呈负相关(r=-0.784,P＜0.05和r=-0.621,P＜0.05).结论 急性心肌梗死患者血清CA125水平升高,并与左室收缩和舒张功能密切相关.     

心肌梗死区存活心肌对糖尿病急性心肌梗死患者PCI术后心功能的影响(英文)

目的:探讨糖尿病急性心肌梗死经皮冠状动脉介入治疗(PCI)术后患者心肌梗死区存活心肌对左室重构及左心功能的影响。方法:208例2型糖尿病并急性心肌梗死PCI术后的患者接受静息状态下18-氟脱氧葡萄糖正电子发射断层扫描术(18F-FDG PET)心肌代谢显像与99m锝-甲氧基异丁基异腈单光子发射型计算机断层成像术(99Tcm-MIBI SPECT)心肌灌注显像,根据心肌梗死区有无存活心肌,分为有心肌存活组(115例,灌注-代谢不匹配)和无心肌存活组(93例,灌注一代谢匹配)。检测两组PCI术前、术后超声心动图各指标,观察心肌梗死区心肌存活状态对于左室重构以及心功能的影响。结果:心肌梗死12个月后有存活心肌组左室射血分数(LVEF)显著高于无存活心肌组[(46.7±6.98)%比(44.1±7.12)%],左室舒张末期内径(LVEDd)[(53.17±4.77)mm比(55.46±4.75)mm],左房内径[(35.89±12.08)mm比(39.25±11.31)mm]显著小于无存活心肌组,P均<0.05。舒张期二尖瓣血流速度峰值的比值12个月后两组无显著差异(P>0.05)。结论:于2型糖尿病合并急性心肌梗死的患者,心肌梗死区有存活心肌患者较无心肌存活患者,LVEF明显改善,左室舒张末期内径显著缩小。     

心电图T波动态变化与急性心肌梗死患者左心室射血分数的关联性分析

目的研究心电图T波动态变化与急性心肌梗死患者左心室射血分数(LVEF)的关联性。方法选取2015年7月~2016年11月我院急性心肌梗死患者174例,依照心电图检查T波情况分为倒置组(n=87)和直立组(n=87),对比两组心功能指标[LVEF、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室峰值充盈时间(LVTPFRv)]、直立组心电图T波恢复直立时间不同患者LVEF水平,分析直立组T波恢复直立时间与LVEF水平相关性。结果两组LVTPFRv对比,差异无统计学意义(P0.05);直立组LVEF、LVEDV高于倒置组,LVESV低于倒置组,差异有统计学意义(P0.05);直立组发病后T波恢复直立时间不同患者LVEF水平对比,差异有统计学意义(P0.05),两两对比,LVEF水平随恢复直立时间缩短而升高,差异有统计学意义(P0.05);经Spearman分析,直立组T波恢复直立时间与LVEF水平呈负相关(r=﹣0.625,P=0.017)。结论直立组心功能高于倒置组,急性心肌梗死患者心电图T波动态变化与其心功能密切相关,临床监测患者心电图T波动态变化有助于评估其心功能,可为临床病情程度及预后判断提供主要参考依据。     

老年急性前壁心肌梗死后相关导联倒置T波正常化的意义

目的　探讨老年急性前壁心肌梗死后相关导联倒置T波正常化的意义。方法　 74例老年急性前壁心肌梗死患者分为T波倒置组 (Ⅰ组 )、T波直立组 (Ⅱ组 )。Ⅱ组又分为 6个月内T波直立组 (Ⅱa组 )和 12个月内T波直立组 (Ⅱb组 )。测定入院时血清肌酸激酶、肌酸激酶同工酶峰值。超声心动图检测梗死后 1个月、12个月左室舒张末期容积指数、收缩末期容积指数、射血分数、室壁运动积分指数、二尖瓣舒张早期及晚期血流速度峰值 (E峰、A峰 )、E A比值。结果　Ⅱ组各项左室功能指标梗死后 12个月明显改善 (P <0 .0 1) ;梗死后 12个月Ⅰ、Ⅱ组各项指标比较差异显著 (P <0 .0 1) ,Ⅱa、Ⅱb亚组左室收缩功能指标有显著差异 (P <0 .0 5 )。结论　老年急性心肌梗死后倒置T波正常化出现标志左室功能改善 ,且出现时间越早 ,慢性期左室功能指标改善越明显     

Correlation between non-reversible thallium-201 myocardial perfusion defect and ECG criteria in the diagnosis of apical myocardial infarction

BACKGROUND: ECG identification of apical myocardial infarction (MI) is controversial and lacks of accuracy. Our aim was to investigate the sensitivity of different proposed ECG criteria in the presence of apical perfusion defects assessed with SPECT analysis. METHODS: One hundred twenty-four (98 M, 26 F) out of 1500 patients with suspected coronary artery disease, showed apical perfusion defect not reversible at rest and after reinjection at tomographic SPECT analysis during thallium-201 scintigraphy. RESULTS: In the group of 29 patients presenting wide isolated apical perfusion defect (wAPD) Q waves in anterior segments with definition of antero-septal MI was prevalent (51.7%), while few patients (41.3%) presented the ECG criteria of apical MI as proposed in the literature. In 19 of the 25 patients with partial isolated apical perfusion defect (pAPD), the absence of Q wave was clearly prevalent. Fifty patients had a wAPD partially extended in surrounding regions, as anterior or septal, inferior or lateral myocardial segments, in these patients, the site of Q wave location was more variable, with prevalent Q wave in anterior leads, but with more incidence of Q waves in leads II III aVF, especially in patients with associated perfusion defect in inferior segments. Substantially, the same finding resulted in the 20 patients showing a pAPD extended in surrounding myocardial segments. CONCLUSION: In conclusion, the low diagnostic sensitivity of the ECG criteria of identification of apical MI is clearly demonstrated by our analysis carried out using SPECT perfusion scintigraphy, with ECG findings of anterior/anterior-septal myocardial necrosis in the patients with wAPD.     

Incidence and prognostic significance of anterior precordial ST segment depression in acute inferior myocardial infarct

In order to evaluate the incidence and prognostic significance of anterior precordial ST segment depression (decreases ST) in acute inferior myocardial infarction (MI), 158 patients with inferior MI were selected. In 90 patients (56.9%) an anterior decreases ST was associated with inferior lesion wave (group A), and in 68 patients (43.1%) only an ecg pattern of inferior myocardial infarction (group B) was present. No significant statistical differences were observed in mortality (group A 10% vs group B 10.2%), in compliances (group A 54.4% vs group B 47.0%) and in higher peak serum ck-levels (group A 83.3% vs group B 69.1%) in two groups during hospitalization period. In conclusion the anterior decreases ST during inferior MI should not be considered a negative prognostic sign. These favourable results are probably related to stringent criteria for ecg diagnosis of inferior myocardial infarction used and to exclusion of all patients with non contemporary evolution of anterior decreases ST and inferior lesion wave.     

急性ST段抬高性前壁心肌梗死患者的右心室功能分析

目的:评价急性前壁ST段抬高性心肌梗死直接经皮冠状动脉成形术(PCI)患者的右心室收缩和舒张功能变化。方法:分析46例急性前壁ST段抬高性心肌梗死患者[前降支近端完全闭塞者24例(前降支近端闭塞组),前降支远端急性闭塞者22例(前降支远端闭塞组)]直接PCI和35例冠状动脉造影"正常"患者(对照组)的临床、冠状动脉造影和心电图资料。采用二维心脏超声分别测定入选患者的右心室舒张末期容积(RVEDV),右心室收缩末期容积(RVESV),右心室射血分数(RVEF),平均肺动脉压(MPAP),左心室舒张末期容积(LVEDV),左心室收缩末期容积(LVESV),左心室射血分数(LVEF)和心脏指数(CI)。结果:与对照组相比,前降支远端闭塞组的平均肺动脉压无显著性差异(P>0.05),而右心室舒张末期容积和收缩末期容积增大,右心室射血分数降低;左心室舒张末期容积和收缩末期容积增加,左心室射血分数、心脏指数减低(P均<0.01)。与前降支远端闭塞组比较,前降支近端闭塞组的左心室舒张末期容积和收缩末期容积增加(P<0.01),心脏指数和左心室射血分数减少(P<0.01),右心室舒张末期容积收缩末期容积和平均肺动脉压增加(P<0.05～0.01),右心室射血分数降低(P<0.01)。多元线性回归分析表明前降支近端闭塞与右心室射血分数降低(R2=0.38,P<0.01)、右心室舒张末期容积增加(R2=0.410,P<0.01)有较好的相关性。2周后,前降支近端和远端闭塞组的右心室舒张末期容积、右心室收缩末期容积、平均肺动脉压和右心室射血分数无明显差异,而前降支近端闭塞患者的左心室舒张末期容积和收缩末期容积增大,左心室射血分数和心脏指数较低(P均<0.01)。结论:提示前降支近端闭塞可能伴右心室前壁部分心肌梗死导致右心室收缩和舒张功能障碍。     

Significance of U wave polarities in previous anterior myocardial infarction

The significance of the polarity of U waves in left precordial leads was evaluated in relation to myocardial perfusion (T1 201 myocardial scintigraphy) and left ventricular function (99m Tc radionuclide ventriculography) in 63 patients with clinical and electrocardiographic evidence of a previous anterior myocardial infarction. Patients were divided into three groups according to the polarity of the U waves: positive U waves, flat U waves, and negative U waves. Twelve matched patients served as normal controls. The following parameters were analyzed: (1) total number of abnormal Q waves; (2) total myocardial perfusion index and regional myocardial perfusion index; (3) global ejection fraction; (4) regional ejection fraction; and (5) number of diseased coronary arteries. The total myocardial perfusion index values were 43.9 +/- 1.0 in controls, 40.8 +/- 3.4 in the positive U wave group, 33.4 +/- 3.5 in the flat U wave group, and 30.3 +/- 4.4 in the patients with negative U waves. Global ejection fractions in these groups were, respectively, 63.9 +/- 8.6%, 65.0 +/- 11.8%, 53.6 +/- 8.1%, and 36.5 +/- 13.6%. The sensitivity of negative U waves suggesting a global ejection fraction of less than 45% was 91.6%, and the specificity was 82.1%. Therefore the size of myocardial infarction increased and left ventricular function decreased, in order, from patients with positive U waves, to those with flat U waves, to those with negative U waves, with statistically significant differences.(ABSTRACT TRUNCATED AT 250 WORDS)     

Normalization of negative T waves in the chronic stage of Q wave anterior myocardial infarction as a predictor of myocardial viability

We investigated whether spontaneous normalization of negative T waves (TWN) on infarct-related ECG leads (IRLs) in the chronic phase of Q wave anterior myocardial infarction (MI) could be a predictor of residual viability in infarct areas. We prospectively studied 35 patients (age 60 +/- 8.6 years) in the chronic phase of Q wave anterior MI. Spontaneous TWN (group A, n = 23) were defined as negative T waves that became upright (> or =0.15 mV) in > or =2 IRLs. The presence of negative T waves (group B, n = 12) was defined as symmetric or biphasic negative T wave of > or =0.15 mV. All patients underwent same-day rest 201Tl-stress (99m)Tc sestamibi dual-isotope myocardial perfusion SPECT and 24-hour 201Tl reinjection imaging for ischemia and viability analysis. On scintigraphic examination, ischemic or viable myocardial segments were found in 18 patients (78%) with TWN and 4 patients (33%) of group B (p = 0.013). The use of TWN as a parameter had a marked influence on the sensitivity (82%), specificity (62%), positive (78%) and negative (67%) predictive values and accuracy (74%) of the diagnosis of viable myocardium. If we add the criterion of positive T waves in aVR with negative T waves to our criteria, we found that sensitivity (90%), positive (80%) and negative (80%) predictive values and accuracy (80%) increased. The results of our study suggest that analysis of TWN on IRLs is an accurate marker of residual viability and/or persistent peri-infarct ischemia in patients in the chronic stage of Q wave anterior MI, and therefore optimizes the diagnostic and therapeutic strategies after MI.     

The noninvasive diagnosis of right ventricular infarction

We evaluated scintigraphy and echocardiography for the diagnosis of right ventricular (RV) infarction. Of 26 patients with acute transmural myocardial infarction (MI), six with inferior MI had abnormal radionuclide uptake localized to the RV free wall on infarct scintigraphy or segmental akinesis of the RV free wall on gated radioangiography or both. These six patients with RV involvement (group I) were compared with the remaining nine with inferior MI (group II) and 11 with anterior MI (group III). RV/LV area ratios determined radioangiographically were significantly greater in group I than group II in diastole and systole. Echocardiographic RV enddiastolic dimension and RV/LV end-diastolic dimension ratio were significantly greater and RV stroke work index was significantly lower in group I than in group II. Predominant RV involvement in inferior MI may occur commonly. Anatomic and functional evidence of this diagnosis can be obtained noninvasively.     

糖尿病和非糖尿病急性前壁心肌梗死晚期成功血运重建术后左室功能的变化及其与存活心肌的关系

目的:比较糖尿病和非糖尿病前壁急性心肌梗死(AMI)晚期成功血运重建术对心肌梗死后远期左室功能和预后的影响以及与存活心肌的关系.方法:选择依据病史、心电图和心肌损伤标志物等检查证实为首次发作的前壁AMI,并于发病后2周左右接受冠状动脉介入治疗术(PCI)的患者共计125例,其中参照WHO诊断标准确诊为并发糖尿病者(A组)43例,未并发糖尿病者(B组)82例.PCI前行超声心动图检查,了解左室功能和梗死相关区域存活心肌的情况.详细分析和记录PCI前后冠状动脉造影的结果.并分别于PCI前和术后6 h、24 h采取静脉血检测血清CK-MB和肌钙蛋白T水平.术后6个月重复超声心动图检查,了解左室功能和室壁活动异常的变化,并随访其间主要心血管事件的发生情况.结果:冠状动脉造影显示,与B组相比,A组PCI后即刻靶血管TIMI 2级血流所占的比例较多,TIMI 3级较少(分别为P<0.05和P<0.01).术后CK-MB和肌钙蛋白T增高者A组明显多于B组(25.6%∶9.8%,P<0.05).小剂量多巴酚丁胺超声负荷试验结果示A组中62.8%和B组中56.1%的患者有存活心肌,2组相比差异无统计学意义(P>0.05).急性期2组左室射血分数(LVEF)、左室舒张末期容积指数(LVEDVI)、收缩末期容积指数(LVESVI)以及室壁运动积分(WMS)基本相同(均P>0.05).术后6个月随访,B组WMS明显减少,LVEF明显增高;而A组LVEF和WMS均无明显改善,LVEDVI反而增加;2组相比LVEDVI、LVESVI、LVEF和WMS均有明显差异(分别P<0.05和P<0.01).随访期间2组主要心血管事件的发生率差异无统计学意义(18.6%∶11.0%,P>0.05).结论:糖尿病AMI晚期成功血运重建对远期左室功能的改善作用较非糖尿病者差,其结果可能与糖尿病患者晚期PCI后缺血心肌未能得到有效再灌注或再灌注加重心肌损伤有关,而术前存活心肌可能不是影响其疗效的主要原因.     

经冠状动脉自体骨髓干细胞移植治疗急性前壁心肌梗死的临床研究

目的 评价经冠状动脉自体骨髓干细胞（MSCs）移植治疗急性前壁心肌梗死的有效性和安全性.方法 入选我院心内科急性前壁心肌梗死住院患者20例,随机分成两组,每组10例.治疗组PCI后经冠状动脉行骨髓干细胞移植,对照组单纯PCI治疗.出院前及移植后定期复查心脏彩超、心肌核素显像（SPECT）及6 min步行试验.结果 ①心脏彩超检查：治疗组术后心功能逐渐好转,随访6个月左室射血分数（LVEF）由（50.5±6.6）%提高至（63.9±7.9）%（P＜0.05）,与对照组比较,差异有统计学意义（P＜0.05）.②SPECT：对照组无明显变化,治疗组心肌灌注显像明显改善.③6 min步行试验：随访6个月,两组较出院前均明显改善（P＜0.05）,组间比较差异无统计学意义（P＞0.05）.结论 经冠状动脉自体MSCs移植治疗急性前壁心肌梗死安全、有效,可能与MSCs再生心肌、抑制心室重构、改善心功能有关.     

T wave normalization during dobutamine stress testing in patients with non-Q wave myocardial infarction. A marker of myocardial ischaemia?

Conflicting results in a heterogenous patient population havebeen described on the functional significance of stress-inducedT wave normalization in the ECG. The aim of this study was toevaluate the relationship between T wave normalization duringdobutamine stress testing and stress-induced ischaemia evaluatedby echocardiography and myocardial perfusion scintigraphy inpatients with previous non-Q wave myocardial infarction. Among520 patients who underwent dobutamine stress testing in conjunctionwith simultaneous echocardiography and 201 thallium or sestamibiSPECT for evaluation of suspected myocardial ischaemia, 36 wereselected according to the following criteria: previous non-Qwave myocardial infarction, normal QRS, negative T waves intwo or more ECG leads and no significant ST segment depressionor elevation at rest or during stress. Diagnosis of ischaemiarelied upon the occurrence of reversible perfusion defects byscintigraphy and stress-induced wall motion abnormalities byechocardiography. During the test, T wave normalization (definedas a resting negative T wave becoming upright in one or moreECG leads during stress) occurred in 20 patients (group 1),while in 16 patients the T waves remained negative (group 2).The prevalence of ischaemia was higher in group I than in group2 both by scintigraphy (85% vs 38%, p=0.004) and by echocardiography(70% vs 32%, p=0·02). The sensitivity, specificity andaccuracy of T wave normalization in the detection of ischaemiawere 74%, 77% and 75% by SPECT and 74%, 65% and 69% by echocardiographyrespectively. CONCLUSION: In patients with non-Q wave myocardial infarction and suspectedmyocardial ischaemia, T wave normalization without concomitantECG changes during dobutamine stress testing is associated witha higher prevalence of ischaemia compared to patients with persistentT wave inversion. This ECG finding should not be disregardedas a marker of ischaemia in that particular patient population.