Prognostic value of myocardial viability detected by myocardial contrast echocardiography early after acute myocardial infarction
Prognostic value of myocardial viability detected by myocardial contrast echocardiography early after acute myocardial infarction
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DOI：
10.1016/j.jacc.2007.03.036
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发表时间：
2007-07-24
影响因子：
24
通讯作者：
Senior, Roxy
中科院分区：
文献类型：
--
作者：
Dwivedi, Girish;Janardhanan, Rajesh;Senior, Roxy
目的探讨心肌声学造影剂超声心动图(MCE)检测急性心肌梗死(AMI)后残存心肌是否能预测硬性心脏事件的发生。背景心肌超声心动图(MCE)检测心肌存活率可预测急性心肌梗死(AMI)患者左心功能的恢复，但迄今尚无研究表明其对急性心肌梗死溶栓后主要不良结局的预测价值。方法99例病情稳定的急性心肌梗死患者在溶栓后7+/-2d行低能量心肌超声心动图(MCE)检查，计算心肌对比缺损度指数(CDI)(1=均匀；2=降低；3=所有16个LV节段的轻度/无混浊)除以16。出院时，65名(68%)患者接受了或计划进行血管重建术，与MCE结果无关。随后对患者进行了心脏性死亡和非致死性心肌梗死的随访。结果99例患者中，95例获得随访。其中86人(87%)接受了溶栓治疗。在46+/-16个月的随访期内，共有15例(16%)事件发生(8例心脏死亡，7例非致死性急性心肌梗死)。在临床、生化、心电图、超声心动图和冠状动脉造影的预后标志物中，残留心肌存活的程度是心脏性死亡(P=0.01)和心脏性死亡或急性心肌梗死(P=0.002)的独立预测因素。一个CDI
Objectives This study sought to determine whether residual myocardial viability determined by myocardial contrast echocardiography (MCE) after acute myocardial infarction (AMI) can predict hard cardiac events.Background Myocardial viability detected by MCE has been shown to predict recovery of left ventricular (LV) function in patients with AMI However, to date no study has shown its value in predicting major adverse outcomes in AMI patients after thrombolysis.Methods Accordingly, 99 stable patients underwent low-power MCE at 7 +/- 2 days after AMI Contrast defect index (CDI) was obtained by adding contrast scores (1 = homogenous; 2 = reduced; 3 = minimal/absent opacification) in all 16 LV segments divided by 16. At discharge, 65 (68%) patients had either undergone or were scheduled for revascularization independent of the MCE result. The patients were subsequently followed up for cardiac death and nonfatal AMI.Results Of the 99 patients, 95 were available for follow-up. Of these, 86 (87%) underwent thrombolysis. During the follow-up time of 46 +/- 16 months, there were 15 (16%) events (8 cardiac deaths and 7 nonfatal AMIs). Among the clinical, biochemical, electrocardiographic, echocardiographic, and coronary arteriographic markers of prognosis, the extent of residual myocardial viability was an independent predictor of cardiac death (p = 0.01) and cardiac death or AMI (p = 0.002). A CDI of