Noninvasive evaluation of coronary reperfusion by transthoracic Doppler echocardiography in patients with anterior acute myocardial infarction before coronary intervention
Noninvasive evaluation of coronary reperfusion by transthoracic Doppler echocardiography in patients with anterior acute myocardial infarction before coronary intervention
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DOI：
10.1161/01.cir.0000103625.15944.62
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发表时间：
2003-12-02
期刊：
影响因子：
37.8
通讯作者：
Tei, C
中科院分区：
文献类型：
--
作者：
Lee, S;Otsuji, Y;Tei, C
经胸多普勒超声心动图（TTDE）能够评价冠状动脉左前降支（LAD）远端血流。本研究的目的是测试TTDE是否可以区分前壁急性心肌梗死（AMI）患者的心肌梗死溶栓（TIMI）3级和TIMI小于或等于2级的冠状动脉再灌注。方法和结果：在46例急诊冠状动脉介入治疗前急性期首次前壁AMI的连续患者中，通过彩色和脉冲TTDE评价前向远端LAD血流的存在及其舒张期峰值速度，并与随后29 ± 12分钟后进行的冠状动脉造影的TIMI分级进行比较。19例患者的TIMI再灌注为0，4例患者的TIMI再灌注为1，10例患者的TIMI再灌注为2，13例患者的TIMI再灌注为3。46例患者中有22例可见远端前降支血流。彩色TTDE显示TIMI 2级和3级再灌注。然而，TIMI 3级患者的脉冲TTDE远端LAD峰值流速明显高于TIMI 2级患者（40+/-10 vs 20+/-6 cm/s，P= 25 cm/s）。TTDE的敏感性、特异性和准确性分别为77%、94%和89%。
Background-Transthoracic Doppler echocardiography (TTDE) enables evaluation of distal left anterior descending coronary artery (LAD) flow. The purpose of this study was to test whether TTDE can differentiate coronary reperfusion with Thrombolysis in Myocardial Infarction (TIMI) grade 3 from TIMI grade less than or equal to2 in patients with anterior acute myocardial infarction (AMI).Methods and Results-In 46 consecutive patients with a first anterior AMI in the acute phase before emergent coronary intervention, the presence of antegrade distal LAD flow and its diastolic peak velocity were evaluated by color and pulsed TTDE and compared with TIMI grades by subsequent coronary angiography performed 29+/-12 minutes later. Nineteen patients had TIMI 0 reperfusion, 4 had TIMI 1, 10 had TIMI 2, and 13 had TIMI 3. Visual antegrade distal LAD flow was present in 22 of the 46 patients. TIMI 2 and 3 reperfusions were both generally visualized by color TTDE. However, peak distal LAD flow velocity by pulsed TTDE was significantly greater in patients with TIMI 3 compared with those with TIMI 2 (40+/-10 vs 20+/-6 cm/s, P= 25 cm/s by TTDE had a sensitivity, specificity, and accuracy of 77%, 94%, and 89%, respectively.Conclusion-TTDE enables noninvasive differentiation of TIMI 3 from TIMI