CORONARY MICROCIRCULATION-ACUTE MYOCARDIAL INFARCTION
冠状动脉微循环-急性心肌梗死
基本信息
- 批准号:6191922
- 负责人:
- 金额:$ 33.16万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2000
- 资助国家:美国
- 起止时间:2000-07-01 至 2005-05-31
- 项目状态:已结题
- 来源:
- 关键词:ACE inhibitors adenosine bioimaging /biomedical imaging clinical research coronary vessels diagnosis design /evaluation disease /disorder classification echocardiography heart disorder chemotherapy heart disorder diagnosis human subject human therapy evaluation microcirculation myocardial infarct sizing myocardial infarction noninvasive diagnosis prognosis reperfusion
项目摘要
DESCRIPTION (The applicant's description verbatim): Despite improved management
strategies for AMI, proper selection of patients for these strategies is still
in its infancy. One of the main reasons is the use of insensitive markers of
acute coronary occlusion, reperfusion, and infarction in the clinical setting.
Routine use of the EKG and cardiac enzymes in patients with AMI, although
inexpensive and easy to perform, has limited our ability to select individual
patients for customized treatment. For instance, we still use EKG to diagnose
AMI despite the fact that only one-third to two-fifth of all AMI patients have
a diagnostic EKG at the time of hospital presentation. We use cardiac enzymes
for the confirmation of AMI, but these become positive several hours after
coronary occlusion, and are of little value in determining immediate management
strategies for patients with AMI. The infarct size can be no larger than the
risk area (the region with hypoperfusion after a coronary artery is occluded).
If the risk area is small, thrombolysis may not be worth the risk and
angioplasty may not be worth the cost. If there is adequate collateral MBF
within the risk area that will maintain myocardial viability, immediate
intervention may not even be necessary. On the other hand, if thrombolysis
fails to achieve tissue reperfusion, rescue angioplasty with or without a drug
that limits microvascular injury may be indicated. Finally, the transmural
extent of infarction may determine which patient will most benefit from an ACE
inhibitor. At present, we do not stratify patients in a manner to optimize
their treatment.
We hypothesize that by imaging the myocardial microvasculature in patients with
suspected AMI we can: 1) detect AMI and determine the ultimate infarct size
despite persistent coronary occlusion. 2) Determine the success of tissue
reperfusion and the effect of intravenous administration of adenosine on
coronary microvascular perfusion and infarct size. 3) Determine the effect of
the extent of microvascular abnormalities after AMI on LV remodeling and the
effect of an ACE inhibitor that causes angiogenesis on this remodeling; and 4)
Determine the long-term prognostic value of normal and abnormal microvascular
perfusion patterns after the initial management of AMI.
We will study the myocardial microvascular using myocardial contrast
echocardiography, a newly developed technique that can provide a noninvasive
assessment of the myocardial microvasculature in humans. The study aims will be
to test the 4 above-mentioned hypotheses in patients with suspected AMI.
描述(申请人的逐字描述):尽管管理有所改善
治疗急性心肌梗死的策略,仍然是正确选择这些策略的患者
在它的初级阶段。其中一个主要原因是使用了不敏感的标记
临床环境中的急性冠脉闭塞、再灌注和梗塞。
急性心肌梗死患者常规应用EKG和心肌酶
价格低廉且易于执行,限制了我们选择个人的能力
为患者量身定做治疗。例如,我们仍然使用EKG来诊断
尽管只有三分之一到五分之二的急性心肌梗死患者有
入院时的诊断性EKG。我们使用的是心肌酶
用于确认急性心肌梗死,但这些在几个小时后转为阳性
冠状动脉闭塞,在确定立即处理方面价值不大
急性心肌梗死患者的治疗策略。梗塞面积不能大于
危险区域(冠状动脉闭塞后低灌注区)。
如果风险区域很小,溶栓治疗可能不值得冒险,
血管成形术可能不值得这样做。如果有足够的抵押品MBF
在将维持心肌存活的危险区域内,立即
干预甚至可能没有必要。另一方面,如果溶栓治疗
未能实现组织再灌注,用或不用药物抢救血管成形术
这可能表明限制了微血管损伤。最后,跨壁画
脑梗塞的范围可能决定哪位患者将从ACE中获益最多
抑制剂。目前,我们没有对患者进行分层优化
他们的待遇。
我们假设,通过对慢性心肌梗死患者的心肌微血管成像
疑似急性心肌梗死我们可以:1)检测急性心肌梗死并确定最终的梗塞范围
尽管有持续性的冠状动脉闭塞。2)决定组织的成败
再灌流及静脉注射腺苷对心肌梗死的影响
冠状动脉微血管灌注量和梗塞面积。3)确定
急性心肌梗死后微血管异常程度对左心室重构的影响
血管紧张素转换酶抑制剂对血管重塑的影响;4)
确定正常和异常微血管的长期预后价值
急性心肌梗死首次治疗后的血流灌注模式。
我们将使用心肌造影剂来研究心肌微血管。
超声心动图,一种新开发的技术,可以提供无创的
人类心肌微血管系统的评估。这项研究的目标是
在疑似急性心肌梗死患者中验证上述4种假说。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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{{ truncateString('SANJIV KAUL', 18)}}的其他基金
Ultrasound-Targeted Therapy for Acute Myocardial Infarction
急性心肌梗死的超声靶向治疗
- 批准号:
7988246 - 财政年份:2010
- 资助金额:
$ 33.16万 - 项目类别:
Ultrasound-Targeted Therapy for Acute Myocardial Infarction
急性心肌梗死的超声靶向治疗
- 批准号:
8502524 - 财政年份:2010
- 资助金额:
$ 33.16万 - 项目类别:
Ultrasound-Targeted Therapy for Acute Myocardial Infarction
急性心肌梗死的超声靶向治疗
- 批准号:
8286079 - 财政年份:2010
- 资助金额:
$ 33.16万 - 项目类别:
Ultrasound-Targeted Therapy for Acute Myocardial Infarction
急性心肌梗死的超声靶向治疗
- 批准号:
8126485 - 财政年份:2010
- 资助金额:
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Gestational Diabetes Leads to Cardiovascular Vulnerability in Offspring
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EFFECT OF RED WINE ON BLOOD VISCOSITY AND CORONARY FLOW RESERVE
红酒对血液粘度和冠状动脉血流储备的影响
- 批准号:
7205529 - 财政年份:2005
- 资助金额:
$ 33.16万 - 项目类别:
CORONARY MICROVASCULATURE IN ACUTE MYOCARDIAL INFARCTION
急性心肌梗塞中的冠状动脉微血管
- 批准号:
7205520 - 财政年份:2005
- 资助金额:
$ 33.16万 - 项目类别:
Imaging of Regional Myocardial Perfusion and Function
局部心肌灌注和功能的成像
- 批准号:
6801197 - 财政年份:2004
- 资助金额:
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Effect Of Red Wine On Blood Viscosity And Coronary Flow Reserve
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