心肌梗死前心绞痛与血管重建术后心肌微循环

目的　应用经静脉心肌声学造影研究心肌梗死前心绞痛与心肌微循环、左心室重构和收缩功能的关系。方法　 5 0例急性心肌梗死患者 ,根据梗死前 1周内有无心绞痛分成心绞痛组 (A组 ,2 7例 )与无心绞痛组(B组 ,2 3例 ) ,均进行超声检查和经静脉心肌声学造影显像。所有研究对象均进行了血管重建术 ,并于术后第 5周复查二维超声。结果　①A组出现术后无再流现象的患者明显低于B组 (P <0 .0 0 1) ;②A、B两组的左心室舒张末期内径 (EDD)在术后第 1周差异无显著性意义 (P >0 .0 5 ) ,而在第 5周差异有显著性意义 (P <0 .0 5 ) ,A组的EDD逐渐减小 (P <0 .0 5 ) ,而B组的EDD差异无显著性意义 (P >0 .0 5 )。③A组的射血分数显著改善 ,而B组的射血分数差异无显著性意义 (P >0 .0 5 )。结论　心肌梗死前心绞痛有利于血管重建术后心肌微循环和左心室重构的改善 ,有助于左心室功能的恢复。

Assessment of the relationship between preinfarction angina and myocardial microcirculation after revascularization

Objective To assess the relationship of preinfarction angina and myocardial microcirculation and cardiac function after revascularization using intravenous myocardial contrast echocardiography (MCE).Methods Fifty patients with acute myocardial infarction,according to presence of angina in one week before infarction,were divided into angina group(Group A) and non-angina group(Group B) by means of MCE (Levovist),and harmonic power Doppler (Philips Sonos 5500) after successful revascularization.Group A consisted of 27 cases, Group B 23 cases.Results The incidence of no flow after the operation (myocardial contrast score index < 0.5 ) was lower in Group A than Group B ( 18.5% vs 60.9% , P < 0.001 ).The end-diastolic dimension (EDD) was not significantly different between Group A and Group B in the first week after revascularization( P > 0.05 ).The EDD decreased significantly in the fifth week after revascularization in Group A,but not changed in Group B( P < 0.05 ).The left ventricular ejection fraction (EF) was improved in Group A.No change of EF was found in Group B( P > 0.05 ).Conclusions Preinfarction preserves microcirculation and cardiac function,helps to improve left ventricular remodeling.