Relationship between microvascular resistance and perfusion in patients with reperfused acute myocardial infarction.
Relationship between microvascular resistance and perfusion in patients with reperfused acute myocardial infarction.
复制标题
急性心肌梗死再灌注患者微血管阻力与灌注的关系。
DOI：
10.1111/j.1540-8183.2007.00274.x
复制
发表时间：
2007
影响因子：
2.1
通讯作者：
S. Umman
中科院分区：
文献类型：
--
作者：
M. Sezer;B. Umman;I. Okçular;Y. Nişancı;S. Umman
未标记
尽管其预后的重要性，ST段抬高急性心肌梗死（STEMI）患者的微血管灌注的准确评估是困难的。微血管阻力指数（IMR）作为一种新的测量工具，为我们了解STEMI后微血管状况提供了新的机会。本研究通过测量梗死相关动脉（伊拉）的IMR，探讨其与其他评价再灌注STEMI患者微血管灌注的指标之间的关系。
方法
前瞻性纳入了42例经直接经皮冠状动脉介入治疗（pPCI）成功治疗的STEMI患者。pPCI术后48 h，采用冠状动脉内压力-温度传感器导丝测量IRA的IMR、冠状动脉血流储备（CFR）、收缩压和平均冠状动脉楔压（CWP和CWPm）、压力衍生侧支血流指数（CFIP）。根据第二次血管造影评估心肌发红等级。经胸超声心动图检查pPCI后48小时的冠状动脉血流速度模式（舒张期减速时间：DDT）。根据体表心电图计算ST段恢复百分比（STR%）。
结果
IMR与CWP（r = 0.70，P < 0.001）、CWPm（r = 0.59，P < 0.001）、CFIP（r = 0.65，P < 0.001）、CFR（r =-0.50，P = 0.001）和DDT（r =-0.59，P = 0.001）相关。IMR与无创/半创指标如心肌发红分级（MBG）（r =-0.42，P = 0.007）和STR（r =-0.37，P = 0.024）的相关性较弱。
结论
由于其测量简单，独立于心外膜狭窄的存在，并与本研究中使用的微血管阻塞的所有措施良好的相关性，IMR可能被证明是一个有价值的模式，用于评估微循环。
UNLABELLED
Despite its prognostic importance, accurate assessment of microvascular perfusion in patients with ST elevation acute myocardial infarction (STEMI) is difficult. As a new tool, the index of microvascular resistance (IMR) measurement provides us a new opportunity for interrogating microvascular condition after STEMI. In this study, we measured IMR in infarct-related artery (IRA) and explored its relation with other indices which have been suggested to evaluate microvascular perfusion in patients with reperfused STEMI.
METHODS
Forty-two patients with STEMI treated successfully with primary percutaneous coronary intervention (pPCI) were prospectively included. After 48 hours following pPCI, patients were recatheterized and IMR, coronary flow reserve (CFR), systolic and mean coronary wedge pressures (CWPs and CWPm) pressure-derived collateral flow index (CFIp) were measured in IRA by using intracoronary pressure-temperature sensor tipped guide wire. Myocardial blush grade was assessed from the second angiogram. Coronary flow velocity pattern (diastolic deceleration time: DDT) was examined with transthoracic echocardiography 48 hours after pPCI. Percentage of ST-segment recovery was calculated from surface ECG (STR%).
RESULTS
IMR well correlated with CWPs (r = 0.70, P < 0.001), CWPm (r = 0.59, P < 0.001), CFIp (r = 0.65, P < 0.001), CFR (r =-0.50, P = 0.001), and DDT (r =-0.59, P = 0.001). Correlations of IMR to non/semiinvasive indices like myocardial blush grades (MBG) (r =-0.42, P = 0.007) and STR (r =-0.37, P = 0.024) are somewhat weaker.
CONCLUSION
Given its simplicity of measurement, independence from the presence of an epicardial stenosis, and good correlation with all measures of microvascular obstruction used in this study, IMR may prove to be a valuable modality for evaluating the microcirculation.
影响因子：
37.8
作者：
RAGOSTA, M;CAMARANO, G;GIMPLE, LW
通讯作者：
GIMPLE, LW