Reperfusion syndrome: Relationship of coronary blood flow reserve to left ventricular function and infarct size
Reperfusion syndrome: Relationship of coronary blood flow reserve to left ventricular function and infarct size
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DOI：
10.1016/s0735-1097(00)00523-4
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发表时间：
2000-04-01
影响因子：
24
通讯作者：
Steg, PG
中科院分区：
文献类型：
--
作者：
Feldman, LJ;Himbert, D;Steg, PG
目的探讨急性心肌梗死(AMI)再灌注综合征(RS)的病理生理机制及其预后意义。方法对21例急性心肌梗死(AMI)患者行直接冠状动脉成形术(PTCA)，观察发病后12h以内的前壁急性心肌梗死(AMI)。用多普勒导丝测量冠脉血流储备(CVR)，作为微循环功能的指标。分别用核素心动图、201T1单光子发射计算机体层摄影术和对比心动图测定左心室射血分数、梗塞面积(缺损率)和左心室收缩末期容量指数(LVESVi)。有RS的患者(10/21)的术后CVR低于无RS的患者(中位数[95%可信区间]：1.2vs.1.6[1.51.7]，p<；0.005)。尽管两组出院前CVR相似，但6周时的梗塞范围(26[21~37]比14[10-17]%(201)T1缺损组，p=0.001)和出院前LVESVI(45%[40~52]比30%[29~38]mL/m(2)，p=0.001)更大，6周时的左心室射血分数(40%[37~46]比55%[50~60])更大，结论急性前壁急性心肌梗死急诊PTCA术中有RS的患者较无RS的患者有一过性CVR降低，但持续存在左心功能不全和较大的心肌梗死面积，提示RS是微循环再灌注损伤的标志。(J Am Coll心脏ol 2000；35：1162-9)(C)2000，由美国心脏病学会出版。
OBJECTIVES We rested the hypothesis that the reperfusion syndrome (RS), defined as an additional elevation of the ST segment upon reperfusion, may be a marker of microcirculatory reperfusion injury during acute myocardial infarction (AMI).BACKGROUND The pathophysiology of the RS is unknown, and its prognostic implications are controversial.METHODS Twenty-one patients with an anterior AMI treated less than or equal to 12 h after onset by primary coronary angioplasty (PTCA) were studied. Coronary velocity reserve (CVR), an index of microcirculatory function, was measured using a Doppler guidewire. Left ventricular (LV) ejection fraction, infarct size (percent defect) and LV end-systolic volume index (LVESVi) were evaluated by radionuclide ventriculography, (201)T1 single-photon emission computed tomography and contrast ventriculography, respectively.RESULTS Baseline ST elevation and pain-to-TIMI 3 time were similar in patients with and without RS. Patients with RS (10/21) had a lower post-PTCA CVR than patients without RS (median [95% confidence interval]: 1.2 [1-1.3] vs. 1.6 [1.5-1.7], p < 0.005). Even though predischarge CVR was similar in the two groups, infarct size at six weeks (26 [21 to 37] vs. 14 [10-17] % (201)T1 defect, p = 0.001) and predischarge LVESVi (45% [40 to 52] vs. 30% [29 to 38] mL/m(2), p = 0.001) were larger, and LV ejection fraction at six weeks (40% [37 to 46] vs. 55% [50 to 60], p = 0.004) was lower in patients with RS than in patients without RS.CONCLUSIONS Patients with RS during primary PTCA for an anterior AMI have a transiently lower CVR than patients without RS, but sustained LV dysfunction and larger infarct size, suggesting that RS is a marker of microcirculatory reperfusion injury. (J Am Coll Cardiol 2000;35: 1162-9) (C) 2000 by the American College of Cardiology.