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。

Influence of viable myocardium in myocardial infract region on cardiac function in diabetic patients with acute myocardial infarction after PCI

Objective： To explore influence of viable myocardium in myocardial infract region on left ventricular re- modeling and left cardiac function in diabetic patients with acute myocardial infarction （AMI） after percutaneous coronary intervention （PCI）. Methods： A total of 208 patients with type 2 diabetes mellitus （T2DM） complicated AMI after PCI underwent myocardial metabolic imaging by 18F-- deoxyglucose position emission tomography （18F --FDG PET） and myocardial perfusion imaging by99mTc--methoxy isobutyl isonitrile single photon emission compu- ted tomography （99mTc--MIBI SPECT）. According to whether there was viable myocardium in myocardial infarct region, patients were divided into viable myocardium group （n= 115, perfusion didn＇t match metabolism） and no viable myocardium group （n=93, perfusion matched metabolism）. Indexes of echocardiography were measured in two groups before and after PCI. Influence of viable myocardium in myocardial infarct region on left ventricular re- modeling and cardiac function was observed. Results.. After myocardial infarction 12 months, compared with no vi- able myocardium group, there was significant increase in left ventricular ejection fraction （LVEF） （44.1 ± 7.12）% vs. （46.7±6.98）% ] and significant decrease in left ventricular end-diastolic dimension （LVEDd） （55.46±4.75）mm vs. （53.17±4.77） mm], left atrial diameter （39.25±11.31） mm vs. （35.89±12.08） mm] in viable myocar- dium group, P〈0.05 all. There were no significant difference in ratio of mitral diastolic peak flow velocity （E/A） in two groups after 12 months （P〉0.05）. Conclusion： In patients with type 2 diabetes mellitus complicated acute myocardial infarction, compared with no viable myocardium patients, LVEF significantly improves, LVEDd signifi- cantly decreases in patients with viable myocardium within myocardial infract region.