Early patency of the infarct-related artery after myocardial infarction preserves diastolic filling.
Early patency of the infarct-related artery after myocardial infarction preserves diastolic filling.
复制标题
心肌梗塞后梗塞相关动脉的早期通畅可保留舒张期充盈。
DOI：
10.1016/s0002-9149(01)01428-x
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发表时间：
2001
期刊：
影响因子：
--
通讯作者：
Stratton,JR
中科院分区：
文献类型：
--
作者：
Levy,WC;Cerqueira,MD;Weaver,WD;Stratton,JR
心肌梗死后梗死相关动脉（伊拉）通畅与死亡率降低、收缩功能增强、左心室重构减少和电稳定性相关。本研究的目的是确定心肌梗死后早期冠状动脉通畅是否与舒张早期充盈比闭合动脉更大相关。在中心实验室对167例接受阿替普酶治疗急性心肌梗死并通过心导管检查确定梗死动脉通畅的患者进行放射性核素心室造影。通过4种不同的方法评估早期充盈率峰值（PEFR）：（1）PEFR（EDV/s）-标准化为舒张末期容积;（2）PEFR（SV/s）-标准化为每搏输出量;（3）PEFR（ml/s/m2）-绝对舒张充盈率;（4）PEFR（PER）-标准化为峰值射血率。IRA闭合患者（n = 16，心肌梗死溶栓[TIMI] 0或1级血流）和伊拉开放患者（n = 151，TIMI 2或3级血流）的年龄、射血分数和心脏容积相似。然而，在伊拉闭塞的患者中，4种舒张期充盈测量方法的PEFR降低了12%-18%（4种方法中的3种，p <0.05）。闭塞组的PEFR（EDV/s）为1.69 ± 0.9，开放动脉组为2.06 ± 0.4 EDV/s（p = 0.005）。通过多变量分析，伊拉通畅率是所有4种方法PEFR的独立预测因素。急性心肌梗死后早期冠状动脉通畅可保持舒张期充盈。舒张功能的改善可以部分解释溶栓治疗后未记录射血分数改善的伊拉的长期获益。
A patent infarct-related artery (IRA) following myocardial infarction has been associated with lower mortality, increased systolic function, decreased left ventricular remodeling, and electrical stability. The purpose of this study was to determine whether coronary artery patency early after myocardial infarction is associated with greater early diastolic filling than a closed artery. Radionuclide ventriculograms were performed at a central laboratory on 167 patients who received alteplase for an acute myocardial infarction and had infarct artery patency determined by cardiac catheterization. The peak early filling rate (PEFR) was assessed by 4 different methods: (1) PEFR (EDV/s)—normalized to the end-diastolic volume; (2) PEFR (SV/s)—normalized to the stroke volume; (3) PEFR (ml/s/m2)—an absolute diastolic filling rate; and (4) PEFR (PER)—normalized to the peak ejection rate. Patients with a closed IRA (n = 16, Thrombolysis In Myocardial Infarction [TIMI] 0 or 1 flow) and patients with an open IRA (n = 151, TIMI 2 or 3 flow) had similar ages, ejection fractions, and cardiac volumes. However, among patients with an occluded IRA, the PEFR was decreased by 12% to 18% by the 4 measures of diastolic filling (3 of 4 methods, p <0.05). PEFR (EDV/s) was 1.69 ± 0.9 in the occluded group versus 2.06 ± 0.4 EDV/s in the open artery group (p = 0.005). By multivariate analysis, IRA patency was an independent predictor of the PEFR by all 4 methods. Early coronary artery patency after an acute myocardial infarction preserves diastolic filling. Improved diastolic function may in part explain part of the long-term benefits of a patent IRA after thrombolytic therapy when there is no documented improvement in the ejection fraction.