Return of left ventricular function after reperfusion in patients with myocardial infarction: importance of subtotal stenoses or intact collaterals.
Return of left ventricular function after reperfusion in patients with myocardial infarction: importance of subtotal stenoses or intact collaterals.
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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。
DOI：
10.1161/01.cir.69.2.338
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发表时间：
1984
期刊：
影响因子：
37.8
通讯作者：
Nath,HP
中科院分区：
文献类型：
--
作者：
Rogers,WJ;HoodJr,WP;Mantle,JA;Baxley,WA;Kirklin,JK;Zorn,GL;Nath,HP
为了确定是否可以通过干预前冠状动脉造影来预测左心室射血分数的后续改善，我们根据症状出现后平均 7 小时的紧急冠状动脉造影结果，将 63 名急性心肌梗死患者分为两组：（1）“无血流”组，梗死相关动脉闭塞且没有明显可见的侧支循环（n = 36）；（2）“血流受限”组，其中任一小计梗死相关血管狭窄或完全闭塞但侧支完整 (n = 27)。在 63 名患者中，61 名接受了紧急手术以建立再灌注。在梗塞后 12 +/- 7 天进行的后续血管造影（造影剂或放射性核素）中，梗塞区血流有限且早期再灌注干预“成功”的患者的整体射血分数显着增加，这主要是由于梗塞区的局部射血分数显着增加。对于没有流向梗塞区且早期再灌注干预“不成功”的患者，总体射血分数在基线和随访期间显着下降，这主要是由于非梗塞区的区域射血分数下降。在梗塞区无血流且早期再灌注成功的患者或梗塞区血流有限且早期再灌注干预不成功的患者中，整体和区域射血分数没有显着变化。再灌注前经过的时间与局部或整体射血分数的变化没有显着相关。然而，随访时前部梗死患者的整体和区域射血分数改善幅度大于下壁梗死患者，可能是因为前部梗死患者的基线射血分数较低。这些数据表明，在症状出现后平均 7 小时接受紧急冠状动脉造影的急性心肌梗死患者中，即使在梗塞区域缺乏保留血流的情况下，即使在成功的早期再灌注干预后，整体射血分数也不太可能出现改善。然而，在梗塞相关动脉次完全闭塞或梗塞区有大量侧支血流的患者中，心肌梗塞区的整体和局部射血分数随后经常出现改善。在最初这些参数受到更严重抑制的患者中，可能更容易证明整体和局部射血分数的改善。
To determine whether subsequent improvement in left ventricular ejection fraction can be predicted from preintervention coronary arteriograms, we divided 63 patients with acute myocardial infarction into two groups based on findings at emergency coronary arteriography at a mean of 7 hr after onset of symptoms: (1) a "no-flow" group with an occluded infarct-related artery and no easily visible collaterals (n = 36) and (2) a "limited-flow" group with either subtotal stenosis or total occlusion of the infarct-related vessel with intact collaterals (n = 27). Of the 63 patients, 61 underwent emergency procedures to establish reperfusion. At follow-up angiography (contrast or radionuclide) performed 12 +/- 7 days after infarction, global ejection fraction had increased significantly in patients with limited flow to the infarct zone and "successful" early reperfusion intervention due primarily to a significant increase in the regional ejection fraction in the infarct zone. Global ejection fraction fell significantly between baseline and follow-up in patients with no flow to the infarct zone and "unsuccessful" early reperfusion intervention due primarily to a fall in the regional ejection fraction of the noninfarct zone. Global and regional ejection fractions did not change significantly in patients with no flow to the infarct zone and successful early reperfusion or in patients with limited flow to the infarct zone and unsuccessful early reperfusion intervention. The elapsed time before reperfusion did not relate significantly to the change in either regional or global ejection fraction. However, the magnitude of improvement in both global and regional ejection fraction at follow-up was greater among patients with anterior infarcts than among those with inferior infarcts, possibly because baseline ejection fraction was lower in patients with anterior infarcts. These data indicate that among patients with acute myocardial infarction undergoing emergency coronary arteriography at a mean of 7 hr after onset of symptoms, improvement in global ejection fraction is unlikely to occur even after a successful early reperfusion intervention in the absence of preserved flow to the infarct area. However, among patients with subtotally occluded infarct-related arteries or significant collateral blood flow to the infarct zone, subsequent improvement in global and regional ejection fraction in the zone of myocardial infarction frequently occurs. Improvement in both global and regional ejection fraction may be more readily demonstrated in patients initially having more severe depression of these parameters.
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