Detection of myocardial viability by contrast echocardiography in acute infarction predicts recovery of resting function and contractile reserve
Detection of myocardial viability by contrast echocardiography in acute infarction predicts recovery of resting function and contractile reserve
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DOI：
10.1016/s0735-1097(02)02962-5
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发表时间：
2003-03-05
影响因子：
24
通讯作者：
Lindner, JR
中科院分区：
文献类型：
--
作者：
Balcells, E;Powers, ER;Lindner, JR
我们试图确定急性心肌梗死（AMI）患者在直接冠状动脉支架植入术（PCS）之前和之后早期进行的心肌声学造影（MCE）心肌声学造影可用于评价PCS术前危险区心肌灌注及术后即刻心肌坏死程度方法：对10例AMI患者于PCS术前、术后3 ~ 5天及4周行MCE及二维超声心动图检查。收缩储备进行了评估多巴酚丁胺超声心动图在4周内持续严重的室壁运动异常的患者。结果段无灌注在3至5天，95%有严重的运动功能减退到运动不能在4周。在3 ~ 5天灌注正常的节段中，90%在4周时室壁运动正常或轻度运动功能减退，而在3 ~ 5天部分灌注的节段中，室壁运动正常、运动功能减退和运动不能均匀分布。在4周时持续严重室壁运动异常的节段中，在>80%的有灌注的节段中发现了收缩储备，相比之下，只有10%的没有可检测到灌注的节段（p < 0.01）。心肌灌注MCE前PCS的存在与维持或改善灌注在3至5天，最终恢复静息室壁motion.CONCLUSIONS心肌造影超声心动图进行后PCS早期梗死的程度提供信息，因此可能恢复静息收缩功能或收缩储备。在PCS之前存在灌注，无论是来自侧支还是顺行血流，都预示着灌注的维持和收缩功能的恢复。(C)2003年由美国心脏病学会基金会。
OBJECTIVES We sought to determine whether myocardial contrast echocardiography (MCE) performed before and early after primary coronary stenting (PCS) in patients with acute myocardial infarction (AMI) could predict recovery of resting left ventricular systolic function and contractile reserve.BACKGROUND Myocardial contrast echocardiography can be used to assess perfusion within the risk area before PCS and the extent of necrosis soon after PCS.METHODS In 30 patients with AMI, MCE and two-dimensional echocardiography were performed before PCS and 3 to 5 days and 4 weeks after PCS. Contractile reserve was assessed by dobutamine echocardiography at four weeks in patients with persistent severe wall-motion abnormalities.RESULTS Of segments without perfusion at 3 to 5 days, 95% had severe hypokinesis to akinesis at 4 weeks. Of segments with normal perfusion at 3 to 5 days, 90% had normal wall motion or mild hypokinesis at 4 weeks, whereas those with partial perfusion at 3 to 5 days were evenly divided between normal wall motion, hypokinesis, and akinesis. In segments with persistent severe wall-motion abnormalities at four weeks, contractile reserve was found in >80% of segments with perfusion, compared with only 10% of segments without detectable perfusion (p < 0.01). The presence of myocardial perfusion by MCE before PCS was associated with maintained or improved perfusion at 3 to 5 days and eventual recovery of resting wall motion.CONCLUSIONS Myocardial contrast echocardiography performed early after PCS provides information on the extent of infarction, and hence the likelihood for recovery of resting systolic function or contractile reserve. The presence of perfusion before PCS, from either collateral or antegrade flow, predicts the maintenance of perfusion and recovery of systolic function. (C) 2003 by the American College of Cardiology Foundation.