Functional improvement of jeopardized myocardium following intracoronary streptokinase infusion in acute myocardial infarction.
Functional improvement of jeopardized myocardium following intracoronary streptokinase infusion in acute myocardial infarction.
复制标题
急性心肌梗死冠状动脉内输注链激酶后受损心肌的功能改善。
DOI：
10.1172/jci110987
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发表时间：
1983
期刊：
影响因子：
--
通讯作者：
GreenfieldJr,JC
中科院分区：
文献类型：
--
作者：
Stack,RS;Phillips3rd,HR;Grierson,DS;Behar,VS;Kong,Y;Peter,RH;Swain,JL;GreenfieldJr,JC
研究了急性心肌梗死后再灌注对局部左心室功能的影响。24例患者在症状发作后6小时内给予冠状动脉内链激酶。15例患者（62%）在初始研究期间成功再通。使用从舒张期和收缩期血管造影轮廓的质心起的23个半径确定危害区和代偿区的平均径向缩短百分比（%RS）。在19例患者24 h重复心导管检查期间和15例患者出院前（16 +/- 11 d）获得连续测量值。在出院前研究时，每例急性再灌注患者的危险区域%RS均有所改善（P = 0.01），56%恢复至正常范围。尽管在每个再灌注患者的危险区域的收缩功能的统一改善，全局射血分数显示没有改善或在慢性研究时下降44%。这是由于在急性和慢性研究之间，每种情况下未受累节段的代偿性室壁运动减少。在无法急性再通的患者中，在慢性研究时，%RS和射血分数均未发生显著变化。这些数据表明：（a）在急性心肌梗死后胸痛的前6小时内进行再灌注的患者中，受损心肌的显著挽救与收缩功能的恢复相关;（B）不能进行急性再灌注的患者的局部或整体左心室性能没有改善;以及（c）射血分数受到未受累节段的代偿性室壁运动变化的强烈影响，并且不能准确地反映受损心肌的收缩功能变化。
The effect of reperfusion on regional left ventricular performance following acute myocardial infarction in man was determined. Intracoronary streptokinase was administered in 24 patients within 6 h of the onset of symptoms. 15 patients (62%) were successfully recanalized during the initial study. Mean percent radial shortening (%RS) in both the jeopardized and compensatory regions were determined using 23 radii from the centroid of diastolic and systolic angiographic silhouettes. Sequential measurements were obtained during repeat cardiac catheterization studies at 24 h in 19 patients and before discharge from the hospital (16 +/- 11 d) in 15 patients. At the time of the predischarge study, each acutely reperfused patient showed improvement in %RS in the jeopardized region (P = 0.01) with 56% returning to the normal range. Despite the uniform improvement in the contractile function of the jeopardized region in each reperfused patient, the global ejection fraction showed no improvement or a decrease at the time of the chronic study in 44%. This was due to a decrease in the compensatory wall motion in the uninvolved segments between the acute and chronic study in each case. Neither the %RS nor the ejection fraction changed significantly at the time of the chronic study in the patients who could not be acutely recanalized. These data indicate (a) significant salvage of jeopardized myocardium associated with recovery of contractile function in patients reperfused during the first 6 h of chest pain following acute myocardial infarction; (b) no improvement in regional or global left ventricular performance in patients who could not be reperfused acutely; and (c) the ejection fraction is strongly influenced by changes in the compensatory wall motion of the uninvolved segments and does not accurately reflect changes in the contractile function of the jeopardized myocardium.