Relationship between tissue reperfusion and postinfarction left ventricular remodelling in patients with anterior wall myocardial infarction treated with primary coronary angioplasty.
Relationship between tissue reperfusion and postinfarction left ventricular remodelling in patients with anterior wall myocardial infarction treated with primary coronary angioplasty.
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发表时间：
2006-04
影响因子：
3.3
通讯作者：
A. Araszkiewicz;M. Lesiak;S. Grajek;M. Prech;A. Cieśliński
中科院分区：
文献类型：
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作者：
A. Araszkiewicz;M. Lesiak;S. Grajek;M. Prech;A. Cieśliński
前言病理性左心室重构被认为是心肌梗死后心力衰竭的主要原因。目的评价急性心肌梗死患者直接冠状动脉成形术后冠状动脉微血管再灌注程度与左室重构的关系。方法本研究包括92例连续患者，因首次前壁心肌梗死住院，接受成功（TIMI-3级血流）的直接冠状动脉成形术。评估血管造影心肌再灌注参数（MBG，校正的TIMI帧数）。所有患者在首次PCI术后3天和6个月行超声心动图检查，计算舒张末期容积（EDV）、左室射血分数（EF）和收缩指数（WMSI）。结果心肌缺血再灌注损伤组（MBG 0-1）32例，组织缺血再灌注损伤组（MBG 2-3）60例。第1组中观察到的负性左心室重构频率高于第2组（28.1% vs 10%，p=0.029）。第1组中出现心力衰竭症状的患者更多（56.3% vs 25%，p=0.013）。结论：在接受直接冠状动脉成形术治疗的心肌梗死患者中，通过血管造影指数（MBG 0-1）评估的组织再灌注失败与心肌梗死后6个月不良心肌重塑和心力衰竭的发生率较高相关。
INTRODUCTION Pathological left ventricular remodelling is considered the main cause of heart failure in patients after myocardial infarction. AIM The purpose of this study was to evaluate correlations between the degree of coronary microvascular reperfusion assessed by means of the angiographic myocardial blush grade (MBG) scale and adverse left ventricular remodelling in patients with acute myocardial infarction treated with primary coronary angioplasty. METHODS This study involved 92 consecutive patients, hospitalised because of their first anterior wall myocardial infarction, who underwent successful (TIMI-3 grade flow) primary coronary angioplasty. Angiographic myocardial reperfusion parameters (MBG, corrected TIMI Frame Count) were assessed. Three days and 6 months after the index PCI all patients underwent an echocardiographic examination and such parameters as end-diastolic volume (EDV), left ventricular ejection fraction (EF) and contractility index (WMSI) were calculated. RESULTS The patients were divided into two groups: group 1 with impaired myocardial reperfusion (MBG 0-1) (n=32) and group 2 with adequate tissue reperfusion (MBG 2-3) (n=60). Negative left ventricular remodelling was observed more frequently in group 1 than in group 2 (28.1% vs 10%, p=0.029). More patients in group 1 presented heart failure symptoms (56.3% vs 25%, p=0.013). CONCLUSIONS Failure of tissue reperfusion assessed by means of angiographic indices (MBG 0-1) in patients with myocardial infarction treated with primary coronary angioplasty is associated with a higher rate of adverse myocardial remodelling and heart failure at 6 months after myocardial infarction.