Noninvasive prediction of residual blood flow within the risk area during acute myocardial infarction: a multicenter validation study of patients undergoing direct coronary angioplasty.
Noninvasive prediction of residual blood flow within the risk area during acute myocardial infarction: a multicenter validation study of patients undergoing direct coronary angioplasty.
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急性心肌梗死期间危险区域内残余血流的无创预测：对接受直接冠状动脉血管成形术的患者进行的多中心验证研究。
DOI：
10.1016/s0002-8703(97)70046-2
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发表时间：
1997
影响因子：
4.8
通讯作者：
R. Gibbons
中科院分区：
文献类型：
--
作者：
P. Chareonthaitawee;T. Christian;M. O’Connor;P. Berger;S. Higano;J. O’Keefe;M. Spain;C. Grines;R. Gibbons
背景在先前的一项单中心研究中，放射性核素99m-甲氧基异丁基异丁基异氰酸酯(99m-Sestamibi)的侧支循环测量与急性心肌梗死患者的血管造影残余血流(顺行和侧支循环)显著相关，并且是最终心肌梗死面积的独立预测因素。这项研究检验了不同的实验室和成像系统是否可以重现先前描述的对梗死区血流的放射性核素测量。方法与结果77例首次心肌梗死患者(前壁32例，非前壁45例)，分别用有创和无创方法检测梗死区残余血流。所有患者在介入治疗前均于胸痛发作后8h内(4.0±1.5h，1.2~7.9h)行冠状动脉造影，再灌注治疗前静脉注射99mTcSestamibi，注射后1~6h行断层扫描。一个中央核心实验室处理了从三个中心获得的图像，每个中心都有一个独特的相机和计算机系统。三种先前发表的基于急性灌注缺损区严重程度的方法被用来测量到达梗死区的残余血流(最低值、严重程度指数、面积)。直接血管成形术前的顺行(溶栓心肌梗死血流)和侧支循环根据急性血管造影的4分(0~3分)进行盲法分级。这两个级别的简单和被定义为血管造影血流指数，代表残余血流到危险区域。残余血流的三种无创性测量方法均与血管造影血流指数呈高度线性相关：严重指数(p=0.0006)、面积(p=0.003)和最低值(最小/最大计数；p=0.004)。这种关联独立于获取数据的实验室。结论尽管有不同的实验室和摄像系统，放射性核素的残余血流测量与再灌注治疗前的血管造影血流指数高度相关。这些结果表明，这些方法可在更广泛的范围内应用于急性心肌梗死侧支循环和前向血流的无创性测定。(《美国心脏杂志》1997；134：639-46)
Background In a previous study from a single center, radionuclide measures of collateral flow with technetium 99m sestamibi have been shown to be significantly associated with angiographic residual (antegrade and collateral) flow and independent predictors of final infarct size in acute myocardial infarction. This study examined whether the previously described radionuclide measures of blood flow to the infarct zone were reproducible with different laboratories and imaging systems. Methods and Results Residual flow to the infarct zone was assessed by both invasive and noninvasive methods in 77 patients with first-time myocardial infarction (32 anterior, 45 nonanterior). All patients underwent acute coronary angiography before any intervention within 8 hours of the onset of chest pain (4.0 ± 1.5 hours; range 1.2 to 7.9 hours).99mTc sestamibi was injected intravenously before reperfusion therapy, and tomographic imaging was performed 1 to 6 hours after injection. A central core laboratory processed the acquired images from three centers, each with a unique camera and computer system. Three previously published methods based on the severity of the acute perfusion defect were used to measure residual flow to the infarct zone (nadir, severity index, area). Antegrade (Thrombolysis in Myocardial Infarction flow) and collateral flow before direct angioplasty were blindly graded on a four-point scale (0 to 3) from the acute angiogram. The simple sum of the two grades was defined as the angiographic flow index, representing residual flow to the jeopardized zone. All three noninvasive measures of residual flow were highly associated with the angiographic flow index in a linear fashion: severity index ( p = 0.0006), area ( p = 0.003), and nadir (minimum/maximum counts; p = 0.004). This association was independent of the laboratory where the data were acquired. Conclusions Despite different laboratories and camera systems, radionuclide measures of residual flow were highly associated with the angiographic flow index before reperfusion therapy. These results suggest that these measures are applicable on a broader scale for the noninvasive determination of collateral and antegrade flow in acute myocardial infarction. (Am Heart J 1997;134:639-46.)
心肌梗死和风险区域关系：通过直接和无创方法进行评估。
影响因子：
9.1
作者：
Cobb,FR;Chu,A
通讯作者：
Chu,A
心肌梗死患者再灌注后左心室功能的恢复：次全狭窄或完整侧支循环的重要性。
影响因子：
37.8
作者：
Rogers,WJ;HoodJr,WP;Mantle,JA;Baxley,WA;Kirklin,JK;Zorn,GL;Nath,HP
通讯作者：
Nath,HP
影响因子：
37.8
作者：
HABIB, GB;HEIBIG, J;BOLLI, R
通讯作者：
BOLLI, R