延迟性PTCA 对急性心肌梗死后左心功能和预后的影响

目的　评价延迟性PTCA对急性心肌梗死 (AMI)后左心功能和心脏事件的影响。方法　38例于AMI 2周后行延迟性PTCA(甲组 )和另 37例仅接受内科治疗 (乙组 ) ,均行住院和随访期ECT(左心室射血分数 ,LVEF)和超声心动图检查 (室壁运动异常积分 )及记录心脏事件发生率。结果　尽管两组平均LVEF相似 ,但甲组中 2 2例和乙组中 11例左心功能改善 (LVEF增加 >5 % ) (P <0 .0 1)。甲组心脏事件发生率 (2 8.9% )较乙组 (67.6% )明显减低 (P <0 .0 5 )。两组心源性病死率为 2 .6%和2 1.6% (P <0 .0 5 )。两组室壁运动异常积分均显著减低 (甲组 :10 .1± 5 .3和 9.0± 2 .9,P <0 .0 1;乙组 :11.6± 3.2和 10 .2± 3.9,P <0 .0 5 )。结论　延迟性PTCA能改善大部分AMI病人的左心功能 ,降低远期心脏事件和心源性病死率     

急性心肌梗死延迟支架植入的临床观察

目的 观察急性心肌梗死病人延迟支架植入无复流的发生率.方法 选择2020年1月-2021年7月以急性心肌梗死入院,发病12 h以内的100例病人为观察对象,冠脉造影后一旦发现血流达到TIMI Ⅲ级,观察15-20 min后血流没有变化,便不再进行干预,返回病房充分抗凝、抗血小板,若病情无变化7-10 d后可复查冠脉造影...     

延迟性PTCA对多支病变急性心肌梗死左心功能和预后的影响

对急性心肌梗死 (ＡＭＩ)后多支病变的患者 ,开通梗死相关动脉 ,是否能改善心功能和预后 ,尚存争议。本文对此问题作一初探。资料与方法一、研究对象1997年 5月～ 1999年 8月连续收治ＡＭＩ 6 3例 ,于发病 7～ 14ｄ行延迟性ＰＴＣＡ及支架术。入选标准 :(1)符合ＷＨＯ诊断标准的ＡＭＩ患者 ;(2 )无肝、肾等器官功能衰竭者 ;(3)随访资料完整者。 6 3例ＡＭＩ患者分单支病变组 (34例 )和多支病变组(2 9例 ,其中 3例急性期心功能Ｋｉｌｌｉｐ 3～ 4级 )。恢复期两组临床心功能均按ＮｅｗＹｏｒｋ分级 ,提高 1级以上为恶化、下降 1级以上为改善…     

彩色多普勒评价射心通胶囊对急性心肌梗死患者左室重构的影响

目的:探讨运用彩色多普勒超声评价射心通胶囊对急性心肌梗死患者左室重构的影响。方法:58例急性心肌梗死患者分为射心通组和培哚普利组,各29例,除常规西医治疗外,射心通组以射心通胶囊治疗3月,培哚普利组以培哚普利治疗3月。治疗前后均运用彩色多普勒测量左室舒张末期内径(LVIDd)、收缩末期内径(LVIDs)、左室舒张末期容积(EDV)、收缩末期容积(ESV)和左室射血分数(EF)并进行比较。结果:两组患者LVIDd、LVIDs、EDV、ESV和EF用药前后均有明显改变(P<0.05),组间疗效比较无统计学差异(P>0.05)。结论:彩色多普勒对射心通胶囊抑制急性心肌梗死后左室重构有较好的评价作用。     

影响高血压病左室重构的因素探讨

 目的探讨高血压病患者引起左室重构的主要危险因素.方法将患高血压病伴肥胖、经心脏B超证实有左室重构者42例,血压管理经24h血压监测,进行随访、追踪5 a,采用logistic回归分析.结果收缩压持续升高伴肥胖者左室重构的系数为1.183,危险度为3.513;长期降压、减肥、运动、饮茶的危险度为负值.结论收缩压持续升高伴肥胖者是引起左室重构的主要危险因素;降压、减肥、运动、饮茶是抑制左室重构的因素.     

成纤维细胞生长因子对大鼠急性心肌梗死后心室重构的影响

目的 探讨心肌内注射人源成纤维细胞生长因子2(hFGF-2)对急性心肌梗死后左心室重构的影响.方法 32只SD大鼠随机均分为对照组和治疗组,建立急性心肌梗死模型,治疗组于梗死心肌周围心肌内注射重组质粒pAdTrace-hFGF2 100μg,对照组给予等量生理盐水.于术后4周取心肌组织行冰冻切片、苏木素-伊红(HE)染色、Ⅷ因子染色和天狼猩红染色观察.结果 术后4周时,治疗组有红色荧光蛋白表达,HE染色及Ⅷ因子染色均可见梗死心肌周围新生血管数目较对照组增多(P<0.05);治疗组左室壁横截而积较对照组增加(P<0.05),但两组左室腔大小、瘢痕心肌厚度及心肌细胞大小无显著差异;治疗组Ⅰ、Ⅲ型胶原含量与对照组比较差异无统计学意义,但Ⅰ/Ⅲ型胶原比值低于对照组(P<0.05).结论 直接心肌内注射FGF-2可能促进血管新生,调节胶原含量及胶原比值,从而改善急性心肌梗死后的心室重构.     

心脏MR延迟强化在急性心肌梗死的应用及研究现状

急性心肌梗死（AMI）梗死心肌、心肌活性和微血管梗阻（MVO）的定量评价对于AMI病人的危险程度分级、治疗决策的制定、治疗效果的评价以及预后评估具有重要意义。心脏MR延迟强化（LGE-CMR）具有较高的时间及空间分辨力,可用于AMI梗死心肌、心肌活性和MVO的定量评价,并且具有较好的可重复性和较高的准确性。就LGE-CMR在AMI的应用及研究现状进行综述。     

PTCA术前后心肌肌钙蛋白Ⅰ的变化及与远期心脏事件的关系

目的：评价经皮冠状动脉腔内成形术（PTCA）对心肌的可能影响。方法：对173例PT－CA术的冠心病患者分别测定其术前、术后血清心肌肌钙蛋白I（cTnI)及肌酸激酶同功酶（CK－MB）,随访各例远期心脏事件,结果42例术前cTnI正常,术后升高;84例术前、术后均正常;47例前、术后均升高。1 CK－MB术前术后均升高,10例CK－MB术后增高,血清cTnI升高与球囊扩张总时间、压力、次数、支架植入数、造影剂用量及术中胸痛发生有关（P＜0．05）。162例在平均21个月的随访期中,26例发生心脏事件,各组间远期心脏事件比较无显著差异（P＞0．05）。结论：用cTnI监测PTCA术患者心肌损伤较CK－MB更敏感和特异;PTCA造成的心肌损伤与操作有关,但并不影响PTCA的疗效。     

ASMA及FAM技术评价缬沙坦对高血压病左室重构的影响

目的：应用自动室壁分区运动分析（ASMA）与全方位M型超声心动图（FAM）技术,评价缬沙坦对原发性高血压病左室重构的影响。方法：原发性高血压病患者178例应用缬沙坦80mg／d口服治疗,疗程12个月。观察治疗过程中患者血压及症状体征的变化情况,并分别在治疗前及治疗后每3个月,分阶段应用ASMA-FAM技术观察心脏形态学变化情况。结果：缬沙坦在治疗2W后血压开始下降,5W后趋于平稳;心腔径：室壁厚度及左室质量指数等在治疗3个月后开始降低（P〈0．05）,6个月～1年后明显下降（P〈0．01）并趋于稳定。结论：缬沙坦能够有效逆转原发性高血压病所导致的左室重构,ASMA—FAM能够全面、客观地定量评价心脏结构及室壁运动状态。     

高压氧处理对急性心肌梗死大鼠心脏微血管功能及心室重构的影响

目的探讨高压氧处理对急性心肌梗死(AMI)大鼠心脏微血管功能及心室重构的影响。方法选取33只雄性SPF级SD大鼠, 按照随机数字表法分为假手术组、模型组和高压氧组, 每组11只。模型组和高压氧组大鼠打开胸腔后在肺圆锥和左心耳之间下缘2～3 mm处进行结扎, 术后缝合胸腔;高压氧组大鼠再进行高压氧处理7次;假手术组大鼠打开胸腔后再进行缝合, 并不进行结扎。应用酶联免疫吸附实验检测大鼠血清肿瘤坏死因子-α(TNF-α)、高敏C反应蛋白(hs-CRP)、白细胞介素(IL)-6和IL-1β含量;运用超声心动图和BL-420F生物机能实验系统检测大鼠心脏功能;Western blotting实验检测大鼠心肌组织磷酸化内皮型一氧化氮合酶(P-eNOS)和血小板内皮细胞黏附分子(PECAM-1)蛋白的表达水平, 并进行Masson及HE染色, 观察心室重构情况。结果与假手术组比较, 模型组大鼠左室射血分数(LVEF)、左室短轴缩短率(LVFS)、左室收缩压(LVSP)、左室内最大上升速率(+dp/dtmax)明显降低, 左室舒张末压(LVEDP)、左室内最大下降速率(-dp/dtmax)明显升高(P...     

Influence of left ventricular hypertrophy on infarct size and left ventricular ejection fraction in ST-elevation myocardial infarction

Background

Left ventricular hypertrophy (LVH) predisposes to larger infarct size, which may be underestimated by the left ventricular ejection fraction (LVEF) due to supranormal systolic performance often present in patients with LVH. The aim of the study was to compare infarct size and LVEF in patients with ST-segment elevation myocardial infarction (STEMI) and increased left ventricular mass on cardiac magnetic resonance (CMR).

Methods

The study included unselected group of 52 patients (61 ± 11 years, 69% male) with first STEMI who had CMR after median 5 days from the onset of the event. Left ventricular hypertrophy (LVH) was defined as left ventricular mass index exceeding 95th percentile of references values for age and gender. Infarct size was assessed with means of late gadolinium enhancement (LGE).

Results

LVH was found in 16 patients (31%). In comparison to the rest of the group, patients with LVH had higher absolute and relative infarct mass (p = 0.002 and p = 0.02, respectively). LVH was related to higher prevalence of microvascular obstruction and myocardial haemorrhage and higher number of LV segments with transmural necrosis (p = 0.02, p = 0.01 and p = 0.01, respectively). Despite marked difference in the infarct size between both studied subgroups there was no difference in LVEF and mean number of dysfunctional LV segments.

Conclusions

Patients with LVH undergoing STEMI have larger infarct size underestimated by the LV systolic performance in comparison to patients without LVH.     

左心室肥厚并急性心肌梗死室性电风暴心电图对预后的影响

目的 探讨沿海居民高血压性左室肥厚(left ventricular hypertrophy,LNH)并急性心肌梗死(acute myocardial infarction,AMI)后心电图特征性改变,评估室性电风暴与临床预后危险分层.方法 选择急诊住院有高皿压性LVH并AMI室性电风暴(室速或室颤)317例(Ⅱ组),另选无高血压性LVH室性电风暴AMI 109例(Ⅰ组)进行心电图检查和持续心电监护,分析心电图特征与临床高危特点.结果 室性电风暴组以高血压LVH并AMI患者心电图指标心房终末电势异常、∑ST段抬高振幅、ST段抬高导联数、QTc间期延长、对应导联ST段振幅下移等特征,梗死部位以前壁或复合前壁,并以左前降支合并回旋支或/和右冠脉完全闭塞多支病变为主,与Ⅰ组比较差异有统计学意义(P<0.05或P<0.01),临床并发泵衰竭、AMI扩展、住院病死率、室性电风暴AMI发病后6 h内发生率明显增多(P<0.01).结论 高血压性LVH并AMI室性电风暴患者,心电图多项指标异常对临床预后有预测作用.     

Survival benefit after revascularization is independent of left ventricular ejection fraction improvement in patients with previous myocardial infarction and viable myocardium

Purpose This study was designed to assess the relationships among myocardial viability, changes in left ventricular (LV) ejection fraction after coronary revascularization and long-term event-free survival in patients with previous myocardial infarction and LV dysfunction. Methods We studied 253 patients with previous myocardial infarction and evidence of dysfunctional viable myocardium as assessed by echocardiography and ^99mTc-sestamibi imaging. Coronary revascularization was performed in 142 patients, while 111 were medically treated. In revascularized patients, echocardiography was repeated 12 months later to detect LV ejection fraction improvement, defined as an increase of 5% compared with baseline. All patients were followed for a mean period of 52±29 months. Cardiac death and non-fatal myocardial infarction were considered as events. Results Event-free survival was higher in revascularized than in medically treated patients (P<0.001). Ejection fraction increased by 5% in 82 (58%) revascularized patients, and the extent of viable myocardium was the strongest predictor of such improvement (P<0.001). Event-free survival was similar for patients with (n=82) and patients without (n=60) LV ejection fraction improvement after revascularization, and it was better in revascularized than in medically treated patients in the presence of either substantial (5 viable segments) or low–intermediate (1–4 viable segments) viability (both P<0.01).Conclusion In patients with previous myocardial infarction and evidence of viable myocardium, coronary revascularization procedures improve outcome at long-term follow-up independently of LV ejection fraction improvement.     

核素心肌显像对急性心肌梗死患者 PTCA后左心室收缩功能变化的评估价值

目的 探讨核素心肌灌注/代谢显像对急性心肌梗死（AMI）患者经皮腔内冠状动脉成形术（PTCA）后左心室收缩功能变化的评估价值。 方法 回顾性分析2015年6月至2017年12月于山西医科大学附属第一医院行PTCA治疗的AMI患者36例,其中男性27例、女性9例,年龄（57.9±12.3）岁。所有患者均在AMI发病1周内行PTCA治疗,并于治疗前3天和治疗后6~8个月行99Tcm-甲氧基异丁基异腈SPECT心肌灌注显像（MPI）和18F-氟脱氧葡萄糖PET/CT心肌代谢显像。根据治疗后左心室射血分数（LVEF）的变化值（ΔLVEF）将患者分为2组：A组为心功能改善组（ΔLVEF≥5%）;B组为心功能未改善组（ΔLVEF＜5%）。采用t检验和χ2检验分析比较2组患者的临床资料、LVEF、高峰射血率（PER）、存活心肌/坏死心肌节段数（S/N）比值及心肌肌钙蛋白I（cTnI）等指标间的差异;采用Logistic回归分析影响左心室收缩功能的相关因素;采用受试者特征工作（ROC）曲线分析预测LVEF改善（ΔLVEF≥5%）的S/N界值。 结果 （1）2组患者的性别、年龄、体重指数、吸烟史、高血压病史、糖尿病史、高脂血症病史、心绞痛病史等差异均无统计学意义（均P＞0.05）。（2）PTCA治疗前,A组和B组间LVEF、PER、cTnI的差异无统计学意义,而S/N比值（A组：1.24±1.06,B组：0.58±0.37）的差异有统计学意义（t=0.824,P=0.042）;PTCA治疗后,2组间LVEF（A组：47±12,B组：38±10）、PER（A组：2.11±0.48,B组：1.71±0.50）、S/N比值（A组：0.73±0.47,B组：0.62±0.39）的差异有统计学意义（t=−2.528、−2.366、−2.514,P=0.016、0.024、0.017）,但cTnI间的差异无统计学意义。（3）Logistic回归分析显示,S/N比值是ΔLVEF的独立影响因素（OR=2.164,P=0.018）。（4）ROC曲线结果显示,以S/N比值预测AMI患者PTCA治疗后ΔLVEF≥5%的界值为0.62,曲线下面积为0.823（95%CI：0.661~0.985）,特异度为85.71%,灵敏度为91.54%。 结论 核素心肌灌注/代谢显像对AMI患者行PTCA治疗后左心室收缩功能变化的评估具有重要的临床价值。     

Diagnosis of left ventricular free-wall rupture after acute myocardial infarction using CT

In patients with acute myocardial infarction, left ventricular free-wall rupture (LVFWR) is a well-recognized complication associated with high mortality. Accurate diagnosis of LVFWR allows successful surgical treatment and may improve survival rates. We report on two patients initially evaluated with a presumed diagnosis of thoracic aortic dissection. In both cases CT revealed the presence of LVFWR.     

急性心肌梗死后心脏破裂临床分析

目的分析急性心肌梗死(AMI)后并发心脏破裂(CR)患者的一般资料、临床特征、早期诊断、防治方法以及预后等,以期寻找预防CR的有效手段。方法选取2011年8月至2015年12月解放军306医院心血管内科收治的AMI患者1 639例为研究对象。其中,经超声证实为CR的患者15例设为A组,其余1 624例非CR患者设为B组,比较并分析两组患者的一般资料、治疗情况等。结果 CR女性患者的发生率高于男性(P<0.05);CR患者70岁以上比例明显高于70岁以下者(P<0.05);CR患者体质量指数(BMI)<19 kg/m~2者高于BMI>19 kg/m~2者(P<0.05);合并高血压、糖尿病的患者较易发生CR。CR患者中左心室游离壁破裂者13例(86.7%),室间隔穿孔者2例(13.3%);15例患者中诊断为急性非ST段抬高型心肌梗死者1例(6.7%),急性ST段抬高型心肌梗死者14例(93.3%),其中,以前壁以及广泛前壁心肌梗死10例(66.7%)、下壁+正后壁(或同时合并右室)4例(26.7%)。结论 CR是AMI在临床中致命性的并发症,抢救成功率低;高龄、低体质量、女性、前壁心肌梗死等均是CR的易发因素;床旁心动超声图有助于早期诊断,积极的再灌注治疗是预防CR的有效手段。     

Prognostic value of CT-derived left atrial and left ventricular measures in patients with acute chest pain

PurposeTo determine which left atrial (LA) and left ventricular (LV) parameters are associated with future major adverse cardiac event (MACE) and whether these measurements have independent prognostic value beyond risk factors and computed tomography (CT)-derived coronary artery disease measures.Materials and methodsThis retrospective analysis was performed under an IRB waiver and in HIPAA compliance. Subjects underwent coronary CT angiography (CCTA) using a dual-source CT system for acute chest pain evaluation. LV mass, LV ejection fraction (EF), LV end-systolic volume (ESV) and LV end-diastolic volume (EDV), LA ESV and LA diameter, septal wall thickness and cardiac chamber diameters were measured. MACE was defined as cardiac death, non-fatal myocardial infarction, unstable angina, or late revascularization. The association between cardiac CT measures and the occurrence of MACE was quantified using Cox proportional hazard analysis.Results225 subjects (age, 56.2 ± 11.2; 140 males) were analyzed, of whom 42 (18.7%) experienced a MACE during a median follow-up of 13 months. LA diameter (HR:1.07, 95%CI:1.01–1.13 per mm) and LV mass (HR:1.05, 95%CI:1.00–1.10 per g) remained significant prognostic factor of MACE after controlling for Framingham risk score. LA diameter and LV mass were also found to have prognostic value independent of each other. The other morphologic and functional cardiac measures were no significant prognostic factors for MACE.ConclusionCT-derived LA diameter and LV mass are associated with future MACE in patients undergoing evaluation for chest pain, and portend independent prognostic value beyond traditional risk factors, coronary calcium score, and obstructive coronary artery disease.