择期经皮冠脉介入术对急性心肌梗死心肌微循环的作用

目的应用心肌声学造影(MCE)评价急性心肌梗死(AMI)患者择期经皮冠脉介入术(PCI)前后的心肌微循环。方法选择20例AMI患者,在择期PCI治疗前、后分别应用声诺维(SonoVue)静脉注射,行间歇触发、二次谐波MCE检查,应用声学密度分析软件(AD)定量测定心肌微循环内造影剂的声学峰值强度(PI)、曲线下面积(AUC)。结果治疗前梗死相关节段的PI、AUC明显低于正常灌注节段(P<0.001);择期PCI治疗后梗死节段的PI、AUC仍明显低于正常节段(P<0.001),但较PCI前明显升高(P<0.001),校正后的PIr、AUCr亦明显升高(P<0.001);而正常灌注节段的PI、AUC在PCI前后无明显变化(P>0.05)。结论MCE可定量评定AMI患者的心肌微循环;择期PCI可改善AMI患者梗死节段的微循环。

Effect of Elective Percutaneous Coronary Intervention on the Myocardial Microcirculation Perfusion in Acute Myocardial Infarction

Objective To evaluate myocardial microcirculation perfusion in acute myocardial infarction(AMI) patients,using myocardial contrast echocardiography(MCE) before and after elective percutaneous coronary intervention(PCI). Methods MCE was performed on twenty AMI patients, using SonoVue intravenous injection, intermittent trigger and second harmonic imaging. The acoustic peak intensity(PI) and the area under curve(AUC) in myocardial microcirculation were quantitated by acoustic densitometry(AD) before and after elective PCI. Results The PI and AUC in infarction-related area were significantly lower compared with normal perfused area(P<0.001) ; After elective PCI, the PI and AUC in the infarction-related area were still significantly lower than perfused area(P<0.001), however, they increased more significantly than PCI was performed(P<0.001). The ratio of PI and AUC between infarction-related area and normal perfused area(PIr, AUCr) increased significantly too(P<0.001). The PI and AUC in normal perfused area were shown no significant difference before and after elective PCI(P>0.05). Conclusion MCE can quantitate microcirculation perfusion in AMI patients. Elective PCI can improve myocardial microcirculation perfusion in the infarction-related area in AMI patients.