MICROVASCULAR INTEGRITY INDICATES MYOCELLULAR VIABILITY IN PATIENTS WITH RECENT MYOCARDIAL-INFARCTION - NEW INSIGHTS USING MYOCARDIAL CONTRAST ECHOCARDIOGRAPHY
MICROVASCULAR INTEGRITY INDICATES MYOCELLULAR VIABILITY IN PATIENTS WITH RECENT MYOCARDIAL-INFARCTION - NEW INSIGHTS USING MYOCARDIAL CONTRAST ECHOCARDIOGRAPHY
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DOI：
10.1161/01.cir.89.6.2562
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发表时间：
1994-06-01
期刊：
影响因子：
37.8
通讯作者：
GIMPLE, LW
中科院分区：
文献类型：
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作者：
RAGOSTA, M;CAMARANO, G;GIMPLE, LW
背景：急性心肌梗死（AMI）后梗死相关动脉（IRA）的通畅程度可能不能反映组织灌注的大小。在AMI动物模型中，心肌细胞坏死与广泛的毛细血管损伤相关。由于心肌超声造影（MCE）可以确定微血管灌注的空间分布，我们假设它可以用于近期AMI患者，以区分具有完整微血管的心肌区域和没有完整微血管的心肌区域。方法与结果105例近期AMI患者（范围1天至4周，中位8天）行心导管置入术。在基线时进行二维超声心动图检查，1个月后再次进行超声心动图检查，以评估梗死区区域功能（1至5分分别表示正常节段和运动障碍节段）。MCE在心导管实验室进行，以评估梗死床内微血管灌注。对比评分指数是通过给梗死区内的各个部分打分得出的（0,0.5和1分别表示无、中等和均匀对比效果），并得出梗死床内的平均得分。根据临床指示进行血运重建术。尽管90例未通畅IRA患者和15例闭塞IRA患者的基线壁运动评分和对比评分指数相似（中位数+/-1四分位数范围，3+/-1 vs 3.5+/-1； P= 0.41），但1个月后，开放IRA患者的壁运动评分明显优于封闭IRA患者（2+/-2 vs 3+/-2， P= 0.05）。在90例开放式IRA患者中，1个月后壁运动评分与对比评分指数有很强的相关性(p=- 0.64, p
Background Patency of the infarct-related artery (IRA) after acute myocardial infarction (AMI) may not reflect the magnitude of tissue perfusion. In animal models of AMI, myocardial cellular necrosis has been associated with extensive capillary damage. Because myocardial contrast echocardiography (MCE) can define the spatial distribution of microvascular perfusion, we hypothesized that it could be used in patients after recent AMI to distinguish myocardial regions that have an intact microvasculature and thus are viable from those without an intact microvasculature and thus are not viable.Methods and Results One hundred five patients with a recent AMI (range, 1 day to 4 weeks; median, 8 days) who were undergoing cardiac catheterization were included in the study. Two-dimensional echocardiography was performed at baseline and repeated 1 month later to assess regional function within the infarct zone (scores of 1 to 5 indicating normal to dyskinetic segments, respectively). MCE was performed in the cardiac catheterization laboratory to assess microvascular perfusion within the infarct bed. A contrast score index was derived by assigning scores to individual segments within the infarct zone (0, 0.5, and 1 denoting no, intermediate, and homogeneous contrast effect, respectively) and deriving the average score within the infarct bed. Revascularization was performed as clinically indicated. Although the baseline wall motion score and the contrast score index were similar in the 90 patients with a patent IRA and the 15 patients with an occluded IRA (median+/-1 interquartile range, 3+/-1 versus 3.5+/-1; P=.41), wall motion score 1 month later was significantly better in those with open IRAs compared with those with closed IRAs (2+/-2 versus 3+/-2, P=.05). In the 90 patients with an open IRA, a strong correlation was noted between wall motion score 1 month later and the contrast score index (p=-.64, P