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.     

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.     

Prediction of functional recovery of viable myocardium after delayed revascularization in postinfarction patients: accuracy of dobutamine stress echocardiography and influence of long-term vessel patency.

OBJECTIVES: We sought to evaluate dobutamine stress echocardiography (DSE) for predicting recovery of viable myocardium after revascularization with cineangiography as a gold standard for left ventricular (LV) function. We studied the influence of late vessel reocclusion on regional LV function. BACKGROUND: Dobutamine stress echocardiography is a well established evaluation method for myocardial viability assessment. In previous studies the reference method for assessing LV recovery was echocardiography, long-term vessel patency has not been systematically addressed. METHODS: Sixty-eight patients with a first acute myocardial infarction (AMI) and residual stenosis of the infarct related artery (IRA) underwent DSE (mean +/- standard deviation) 21 +/- 12 days after AMI to evaluate myocardial viability. Revascularization of the IRA was performed in 54 patients by angioplasty (n = 43) or bypass grafting (n = 11). Coronary angiography and LV cineangiography were repeated at four months to assess LV function and IRA patency. RESULTS: Sensitivity and specificity of DSE for predicting myocardial recovery after revascularization were 83% and 82%. In the case of late IRA patency, specificity increased to 95%, whereas sensitivity remained unchanged. In the 16 patients with myocardial viability and late IRA patency, echocardiographic wall motion score index decreased after revascularization from 1.83 +/- 0.15 to 1.36 +/- 0.17 (p = 0.0001), and left ventricular ejection fraction (LVEF) increased from 0.52 +/- 0.06 to 0.57 +/- 0.06 (p = 0.0004), whereas in five patients, reocclusion of the IRA prevented improvement of segmental or global LV function despite initially viable myocardium. CONCLUSIONS: Dobutamine stress echocardiography is reliable to predict recovery of viable myocardium after revascularization in postinfarction patients. Late reocclusion of the IRA may prevent LV recovery and influence the accuracy of DSE.     

急性前壁心肌梗死后梗死相关血管延迟开通对晚期左室重构的影响

目的探讨急性前壁心肌梗死后,延迟经皮冠状动脉血运重建术(PCI)使梗死相关血管(IRA)开通,对心梗晚期左室重构的影响.方法选择64例急性前壁、前间壁及广泛前壁Q波性心梗后病情稳定,发病10～21天冠脉造影证实左前降支完全闭塞者,依据是否接受成功PCI,分为成功PCI组和对照组,分别于急性期、术后2个月和6个月应用超声心动图随访左室腔大小、左室功能和室壁活动异常,并观察6个月期间心力衰竭事件的发生情况.结果心梗后2个月两组左室射血分数(LVEF)、左室收缩末期容积指数(LVESVI)、左室舒张末期容积指数(LVEDVI)和室壁活动异常(VWMA)积分与急性期相比无明显差异(P＞0.05),急性期和2个月时两组上述各指标之间相比差异也无显著性(均P＞0.05).6个月时两组LVEF和VWMA积分与急性期和2个月相比无明显差异(P＞0.05),但对照组LVEDVI和LVESVI较急性期明显增大(P＜0.01,P＜0.05),且与成功PCI组相比差异具有显著性(P＜0.01,P＜0.05).6个月随访期间心力衰竭事件发生率对照组为19%,成功PCI组2%,但差异缺乏统计学意义(P＞0.05).结论急性前壁心梗后IRA延迟开通能明显减少心梗后晚期的左室重构,而对心梗后早期左室重构的影响不大.延迟PCI可能有利于减少心梗后远期心力衰竭事件的发生.     

急性前壁心肌梗死后梗死相关血管延迟开通对晚期左室重构的影响

目的　探讨急性前壁心肌梗死(AMI)后延迟经皮冠状动脉介入治疗(PCI)使梗死相关动脉(IRA)开通对AMI晚期左室重构的影响。方法　选择64例急性前壁、前间壁及广泛前壁Q波性AMI后病情稳定,发病2~14天,平均(9 .1±2 .3)天冠状动脉造影证实左前降支完全闭塞者,依据是否成功行PCI,分为成功PCI组和对照组,分别于急性期、术后2个月和6个月应用超声心动图随访左室大小、左室功能和室壁活动异常情况,并观察6个月期间心力衰竭事件的发生情况。结果　AMI后2个月两组左室射血分数、左室收缩末期容积指数、左室舒张末期容积指数和室壁活动异常积分与急性期相比差异无统计学意义,急性期和2个月时两组上述各指标之间差异也无统计学意义。6个月时两组左室射血分数和室壁活动异常积分与急性期和2个月相比差异无统计学意义,但对照组左室舒张末期容积指数和左室收缩末期容积指数较急性期明显增大(P<0 .01, P<0. 05 ),且与成功PCI组相比差异有统计学意义(P<0 .01, P<0 .05)。6个月随访期间心力衰竭事件发生率对照组为19%,成功PCI组为2%,但差异无统计学意义。结论　急性前壁AMI后IRA延迟开通能明显减少AMI后晚期的左室重构,而对AMI后早期左室重构的影响不大。延迟PCI可能有利于减少AMI后远期心力衰竭事件的发生。     

梗死相关血管晚期开通对急性心肌梗死后左室功能的影响

目的探讨急性前壁心肌梗死后延迟经皮冠状动脉血运重建术(PCI)使梗死相关血管(IRA)开通对心梗晚期左室功能的影响。方法选择64例急性前壁、前间壁及广泛前壁Q波性心梗后病情稳定,发病10～21d冠脉造影证实左前降支完全闭塞者,依据是否接受成功PCI,分为成功PCI组和对照组,分别于急性期、术后2个月和6个月应用超声心动图随访左室腔大小、左室功能和室壁活动异常,并观察6个月期间心力衰竭事件的发生情况。结果心梗后2个月两组左室射血分数(LVEF)、左室收缩末期容积指数(LVESVI)、左室舒张末期容积指数(LVEDVI)和室壁活动异常(VWMA)积分与急性期相比无明显差异(P>0.05),急性期和2个月时两组上述各指标之间相比差异也无显著性(均P>0.05)。6个月时两组LVEF和VWMA积分与急性期和2个月相比无明显差异(P>0.05),但对照组LVEDVI和LVESVI较急性期明显增大(P<0.01,P<0.05),且与成功PCI组相比差异具有显著性(P<0.01,P<0.05)。6个月随访期间心力衰竭事件发生率对照组为19%,成功PCI组2%,但差异缺乏统计学意义(P>0.05)。结论急性前壁心梗后IRA延迟开通能明显减少心梗后晚期的左室重构,而对心梗后早期左室重构的影响不大。延迟PCI可能有利于减少心梗后远期心力衰竭事件的发生。     

Beneficial Effects of Delayed Opening the Infarct - related Artery on Late Phase Left Ventricular Function in Acute Anterior Myocardial Infarction

Objectives To assess the effect of delayed opening the infarct - related artery(IRA) by percutanous coronary intervention (PCI) on the late phase left ventricular function after acute anterior myocardial infarction. Methods 64 patients with initial Q -wave anterior myocardial infarction and the infarct- related arteries were total occluded conformed by angiogram at 2 to 14 days after onset were divided into successful PCI group and control group (not receiving PCI or the IRA not re - opened). 2 - DE was performed at early phase ( about 3 weeks) , 2 and 6months after onset of AMI respectively to detect the left ventricular function and left ventricular wall motion abnormality (VWMA). The total congestive heart failure events were recorded during 6 months follow-up. Results VWMA scores, left ventricular ejection fraction (LVEF), left ventricular end - diastolic and end-systolic volume indices (LVEDVI and LVDSVI)were similar in 2 groups at early phase and 2 months.There were no differences between early phase and 2months in each group too. VWMA scores and LVEF did not changed at 6 months in each group compared with the early phase and 2 months (P ＞ 0.05 ). But LVEDVI and LVESVI were significantly smaller in the successful PCI group than in the control group (P ＜0.01,P ＜ 0. 05 ). The congestive heart failure events were taken place in 19% of patients in control group compared with 2% in successful PCI group ( P ＞ 0.05 ).Conclusions Although the infarct size does not changed, delayed opening the IRA has beneficial effect to the late phase left ventricular dilatation after acute anterior myocardial infarction.     

急性心肌梗死患者血浆脑钠肽水平变化与急性室壁瘤形成的关系

目的探讨急性心肌梗死(AMI)后,急性左心室室壁瘤(LVA)形成患者血浆脑钠肽(BNP)的动态变化及其与LVA形成和心功能状态的关系。方法首次前壁AMI患者64例,经左室造影(LVG)后分为LVA组(31例)和无LVA组(33例)。采血检测BNP,并于经皮冠状动脉介入治疗(PCI)完成后6个月时检测有创容积和压力各参数。结果LVA组AMI后6 h、第5天和第24周血浆BNP浓度均明显高于无LVA组(P<0.05)。PCI后即刻和术后6个月时,无LVA组左室射血分数(LVEF)、左室舒张末期容积指数(LVEDVI)、左室收缩末期容积指数(LVESVI)、室壁运动积分(WMS)和左室舒张末期压(LVEDP)各参数均高于无LVA组。LVA组BNP峰值水平与PCI后即刻LVESVI、LVEDVI、WMS和LVEDP呈显著正相关(P<0.01),与LVEF呈显著负相关(P<0.01)。LVA组MACE发生率明显高于无LVA组患者(P<0.05),且BNP峰值水平与主要不良心脏事件发生率显著正相关(P<0.05)。结论AMI后BNP的过度分泌参与了AMI后左室重构和LVA的形成,并影响着其后的心室功能。     

急性心肌梗死后延迟冠状动脉介入治疗的疗效

目的评价急性心肌梗死(acute myocardial infarction,AMI)后进行延迟经皮冠状动脉介入治疗(delayed percutaneous coronary intervention,dPCI)对心肌梗死患者的治疗效果。方法dPCI组选择ST段抬高的AMI56例,各例于发病后7～14d实施dPCI,对照组为同期入院而未进行PCI治疗的ST段抬高的AMI47例。两组均常规应用药物治疗。观察住院期间和随访6个月时的主要心血管事件和超声心动图的变化。结果6个月时dPCI组左心室舒张末容积指数(left ventricular end-diastolic volumeindex,LVEDVI)、左心室收缩末期容积指数(left ventricular end-systolic volume index,LVESVI)及左心室射血分数(left ventricular ejection fraction,LVEF)、左心室室壁节段运动评分指数(left ventricular wall motion score index,WMSI)及异常室壁节段恢复率优于对照组,dPCI组总临床事件发生率低于对照组,差异有统计学意义(P<0.05)。结论dPCI可有效抑制左心室重构和改善左心室功能,可能有利于减少远期心力衰竭的发生。     

Long-term beneficial effect of infarct-related artery patency in acute anterior myocardial infarction in patients with poor myocardial viability in the region-at-risk.

BACKGROUND: Several studies have demonstrated the benefit of the patency of infarct-related artery (IRA) in acute myocardial infarction (AMI). However those studies have not been concerned with myocardial viability in the region-at-risk. In the present study the effect of the patency of IRA was investigated in the setting of anterior AMI with poor viable myocardium in the risk region. METHODS AND RESULTS: From 1993 to 1996 patients with a first time anterior AMI and poor viable myocardium in the region-at-risk at 1 month after onset were identified and enrolled. Patients with a totally occluded IRA were included in the Non-Open group (n=44), and patients with a reperfused IRA were included in the Open group (n=49). At 5 years after onset, left ventricular function was better preserved in the Open group than in the Non-Open group (p<0.05). Kaplan-Meier survival curves for cardiac mortality and event-free survival curves revealed poor prognoses in the Non-Open group over a 5-year period (p<0.05, respectively). The advantages of a patent IRA were further seen in health-related quality-of-life outcomes (p<0.05). CONCLUSIONS: Even in patients with poor myocardial viability after an anterior AMI, the patency of the IRA is strongly associated with improved long-term survival, independent of residual myocardium viability.     

厄贝沙坦合用培哚普利对急性心肌梗死后左室重塑的影响

目的观察厄贝沙坦合用培哚普利对急性心肌梗死(AM I)患者左室重塑的影响。方法50例AM I患者随机分为治疗组(26例)和对照组(24例),治疗组在常规治疗基础上加厄贝沙坦及培哚普利,对照组仅加用培哚普利,在第3、6个月时分别采用超声观察左室舒张末期容积指数(LVEDVI)、收缩末期容积指数(LVESVI)、室壁运动指数(WMSI)、射血分数(LVEF)变化。结果2组治疗后,LVESVI、WMSI均减少,LVEF增加,与治疗前相比差异有显著性意义(P<0.05);治疗后治疗组与对照组间比较差异有显著性意义(P<0.05)。结论应用厄贝沙坦合用培哚普利能更有效地防治急性心肌梗死后的左室重塑。     

冠状动脉介入治疗对心肌梗死患者室壁瘤逆转和心功能的影响

目的 探讨不同时间段行经皮冠状动脉介入治疗(PCI)对急性心肌梗死(AMI)后左心室室壁瘤(LVA)形成的逆转效应及其对心功能的影响.方法 选择2001年1月至2004年7月我院收治的首次前壁AMI患者,经导管法左心室造影确定合并室壁瘤者共326例,根据AMI发病后行PCI的时间分为:发病≤3 h组、4～6 h组、7～12 h组和1周组(发病时间≥13 h且小于1周),4组患者于PCI后即行导管法左心室造影,测定心室容积、压力参数和室壁运动积分;PCI术后1周时行平衡法核素心室造影,测定反常室壁容积指数;6个月时重复上述检查,并随访3年,记录主要心脏事件(MACE)的发生率. 结果 PCI术后6个月随访,发病≤3 h组、4～6 h组、7～12 h组、1周组左心室舒张末期容积指数、左心室收缩末期容积指数、左心室室壁运动积分、左心室舒张末期压力均较行PCI时降低(均P<0.05),而左心室射血分数较前增高(P<0.05),其中发病≤3 h组变化最为显著.PCI术后6个月,发病≤3 h组反常室壁容积指数明显低于4～6 h组、7～12 h组、1周组,分别为:(12.1±2.1)%与(15.4±2.4)%、(16.5±2.5)%、(20.4±3.7)%,均P<0.05.住院期间及术后3年随访,≤3 h组、4～6 h组、7～12 h组3组MACE发病率低于1周组,3年随访时病死率均低于1周组(分别为2.8%、3.0%、3.1%与17.9%,均P<0.05). 结论 对AMI患者越早期开通梗死相关动脉,越能有效地抑制并逆转LVA的形成,提高左心室功能,改善患者的预后.     

99Tcm-MIBI 心肌灌注显像及18F-FDG PET心肌代谢显像探测左心室室壁瘤心肌存活性的临床价值

目的 评估99锝m-甲氧基异腈(99Tcm-MIBI)单光子发射计算机断层(SPECT)心肌灌注显像及18F-脱氧葡萄糖(FDG)正电子发射断层(PET)心肌代谢显像探测左心室室壁瘤(室壁瘤)心肌存活性的临床价值.方法 46例确诊为室壁瘤合并左心功能不全[左心射血分数(LVEF)36%±7%],行99Tcm-MIBI SPECT+18F-FDG PET显像,并接受血运重建术的患者,随访(80±27)个月.根据室壁瘤是否有存活心肌[灌注-代谢不匹配分(MMS)≥2.0分]以及是否行室壁瘤切除术,将患者分为4个小组:室擘瘤无存活心肌(A组):血运重建术为Al组(n=8),血运重建术+瘤切除术为A2组(n=15);窒壁瘤有存活心肌(B组):血运重建术为B1组(n=10),血运重建术+瘤切除术为B2组(n=13).结果 A1、A2、B1、B2 4个组心脏事件发生率分别为25%(2/8),40%(6/15).20%(2/10)和31%(4/13)(P＞0.05).除A1组外,其他各组的术后左心功能均得到明显改善(P＜0.05).多因素logistic回归分析筛选出与术后LVEF改善相关的独立影响因素,为左心室的MMS(OR=2.34,95% CI 1.08～5.06,P＜0.05),非室壁瘤部位的心肌灌注分(OR=0.24.95% CI 0.07～0.85,P＜0.05)和远端血管病变(OR=0.008,95% CI 0.001～0.560.P＜0.05).结论 室壁瘤接受血运重建术的患者,长期预后良好.室壁瘤部位有存活心肌的患者,单纯的血运重建术也可以明显改善左心功能,且与心肌存活的量相关.     

Late percutaneous coronary intervention for the totally occluded infarct‐related artery: A meta‐analysis of the effects on cardiac function and remodeling

Background : Late percutaneous coronary intervention (PCI) of a totally occluded infarct‐related artery (IRA) in stable patients is currently not recommended based on the lack of clear clinical benefits in randomized controlled trials. We sought to perform a systematic review and meta‐analysis of randomized controlled trials comparing PCI with optimal medical therapy in patients with IRA occlusion more than 12 hr after onset of acute myocardial infarction (AMI), focusing on left ventricular function and remodeling. Methods and Results : PubMed, CENTRAL, and mRCT were searched for eligible studies. Studies were included in the analysis if they were randomized controlled trials comparing conservative medical management with PCI performed at least 12 hr after the onset of symptoms of AMI, and data on left ventricular ejection fraction (LVEF) at baseline and follow‐up were available. Studies were excluded if randomization occurred less than 12 hr after symptom onset, or if patients were hemodynamically unstable. Change in LVEF was the primary outcome of interest, with changes in left ventricular end‐diastolic volume index (LVEDVI) and end‐systolic volume index (LVESVI) analyzed as secondary endpoints. We retrieved five studies in which baseline and follow up LVEF data were available enrolling a total of 648 patients: 342 patients randomized to PCI and 306 to medical treatment. There was a statistically significant difference in LVEF changes over time favoring PCI (+3.1%, 95% CI +1.0 to +5.2, P = 0.0004). In addition, there were statistically significant differences changes in both LVEDVI (?5.1 ml in favor of PCI, 95% CI of ?9.4 to ?0.8, P = 0.020) and LVESVI (?5.3 ml in favor in PCI, 95% CI of ?8.3 to ?2.4, P = 0.0005). Conclusions : This meta‐analysis suggests that late revascularization of an occluded IRA may improve left ventricular systolic function and remodeling, supporting the “open artery hypothesis.” The reason why these changes have not resulted in clinical benefits in large clinical trials is subject to debate. © 2008 Wiley‐Liss, Inc.     

血运重建对冠心病合并心功能不全患者心肌收缩功能和心室重构的影响

目的探讨血运重建对冠心病合并左心功能不全患者心肌收缩功能和心室重构的影响。方法86例冠心病合并心功能不全患者术前应用超声心动图进行心功能、左心室(左室)几何形态和心肌活性评定,分为有存活心肌组和无存活心肌组,两组分别行血运重建或药物治疗。随访(13±5)个月后重新评价上述指标。结果57例有存活心肌的患者中行血运重建者较药物治疗者左室射血分数(LVEF)、存活节段数、左室球状指数(LVSI)明显提高;左室舒张末容积(LVEDV)、左室收缩末容积(LVESV)、左室重量(LVM)明显降低(P值均<0.01)。29例无存活心肌的患者中上述指标两种治疗间无显著性差异(P值均>0.05)。结论血运重建能改善冠心病合并左心功能不全但有存活心肌患者的心肌收缩功能和几何形态。     

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。     

急性心肌梗死患者早期血浆脑钠素与左室重塑的关系

目的　探讨急性心肌梗死 (AMI)早期血浆脑钠素与左室重塑的关系。方法　 44例AMI患者分为依那普利组及常规治疗组 ,采用放射免疫法测定入院后 14d内血浆脑钠素水平 ;超声心动图测定同期及 3个月左室舒张末容积指数 (LVEDVI)、左室收缩末容积指数 (LVESVI)及左室射血分数 (LVEF)。结果　常规治疗组入院后即刻血浆脑钠素水平较健康对照组明显升高 (P <0 .0 1) ,5、14d较入院即刻进一步升高 (P <0 .0 5 )。AMI患者 5、14d血浆脑钠素水平与同期及 3个月LVEDVI、LVESVI正相关 (P <0 .0 5 ,0 .0 1)。与常规治疗组相比 ,依那普利组脑钠素与心室容积指数一致性下降。结论　AMI后早期血浆脑钠素升高与左室重塑密切相关。     

AMI患者PCI后心肌灌注水平对心功能及左室重构的影响

目的:探讨急性心肌梗死（AMI）患者经皮冠脉介入术（PCI）后TIMI血流III级时的心肌灌注水平及其对心功能与左室重构的影响。方法: 对36例AMI患者PCI后行经静脉心肌声学造影（MCE）和心脏二维超声检查。①利用心肌声学造影评分（MCS）及室壁运动评分(WMS)分析PCI后心肌灌注情况与室壁运动情况的关系;②根据声学造影积分指数（CSI）将患者分为A、B两组,比较两组的左室射血分数（LVEF）,评估心肌灌注水平对心功能的影响;③根据心脏二维超声结果,比较两组患者术后6个月时左室舒张末直径（LVEDD）及LVEF的变化,进一步评估心肌灌注水平对左室重构的影响。结果: PCI后梗死相关血管TIMI血流均达III级。共152节段与梗死相关血管的再灌注有关。①MCS为0分的18节段中,2个（11.1%）WMS为1~2分;MCS为0.5分的30节段中16个（53.3 %）WMS为1~2分;MCS为1分的104节段中,82个（78.8%）WMS为1~2分;统计学分析显示,PCI后心肌灌注水平与室壁运动呈正相关（P<0.05）。②心肌灌注好的A组LVEF显著大于B组［(52.1±3.4)%,(47.2±2.9)%,P<0.05］。③术后6个月A组的LVEF及LVEDD均无明显变化,B组的LVEF较前有所下降［(47.2±2.9)%,(43.8±4.4)%,P<0.05］,LVEDD较前有所增加［(50.2±2.9) mm,(56.3±3.1) mm,P<0.05］。结论: AMI患者PCI后心肌灌注水平与心功能及左室重构有一定相关性,良好的心肌灌注在一定程度上可以抑制左室重构。     

急诊和择期冠状动脉介入治疗对急性心肌梗死左心室重构和功能的影响

目的评价急性心肌梗死(AMI)患者接受急诊和择期经皮冠状动脉介入(PCI)治疗对左心室重构和收缩功能的影响。方法对48例初次发病,发病时间在12h以内或12～24h之间的AMI患者行急诊PCI术;对27例AMI患者行择期PCI术。于术后2周、3个月和6个月行二维超声心动图测量左心室收缩末容积指数(LVESVI)、左心室舒张末容积指数(LVEDVI)、左心室射血分数(LVEF)和梗死区室壁运动指数(RWMI),并进行对比。结果术后2周、3个月急诊PCI组LVESVI、LVEDVI、LVEF和RWMI均显著优于择期PCI组。两组3个月和6个月时LVESVI、LVEDVI、LVEF及RWMI与2周时比较均有显著改善。至6个月时,两组间LVEDVI、LVEF和RWMI比较差异无统计学意义(P>0.05),而LVESVI差异有统计学意义(P<0.05)。两组间GWMI在各时间点统计差异无统计学意义。结论急诊PCI及择期PCI均可有效抑制左心室重构和改善左心室功能,急诊PCI更优于择期PCI。     

Left Ventricular Remodeling after Late Revascularization Correlates with Baseline Viability

The ideal management of stable patients who present late after acute ST-elevation myocardial infarction (STEMI) is still a matter of conjecture. We hypothesized that the extent of improvement in left ventricular function after successful revascularization in this subset was related to the magnitude of viability in the infarct-related artery territory. However, few studies correlate the improvement of left ventricular function with the magnitude of residual viability in patients who undergo percutaneous coronary intervention in this setting.In 68 patients who presented later than 24 hours after a confirmed first STEMI, we performed resting, nitroglycerin-enhanced, technetium-99m sestamibi single-photon emission computed tomography–myocardial perfusion imaging (SPECT–MPI) before percutaneous coronary intervention, and again 6 months afterwards. Patients whose baseline viable myocardium in the infarct-related artery territory was more than 50%, 20% to 50%, and less than 20% were divided into Groups 1, 2, and 3 (mildly, moderately, and severely reduced viability, respectively). At follow-up, there was significant improvement in end-diastolic volume, end-systolic volume, and left ventricular ejection fraction in Groups 1 and 2, but not in Group 3.We conclude that even late revascularization of the infarct-related artery yields significant improvement in left ventricular remodeling. In patients with more than 20% viable myocardium in the infarct-related artery territory, the extent of improvement in left ventricular function depends upon the amount of viable myocardium present. The SPECT–MPI can be used as a guide for choosing patients for revascularization.