AMI患者PCI后心肌灌注水平对心功能及左室重构的影响

马小茹; 程荣超; 薛 莉; 田家玮; 李学奇

AMI患者PCI后心肌灌注水平对心功能及左室重构的影响

Effect of different myocardial perfusion on cardiac function and left ventricular remodeling in patients with acute myocardial infarction after primary percutaneous coronary intervention

摘要

摘要: 目的:探讨急性心肌梗死（AMI）患者经皮冠脉介入术（PCI）后TIMI血流III级时的心肌灌注水平及其对心功能与左室重构的影响。方法：对36例AMI患者PCI后行经静脉心肌声学造影（MCE）和心脏二维超声检查。①利用心肌声学造影评分（MCS）及室壁运动评分(WMS)分析PCI后心肌灌注情况与室壁运动情况的关系；②根据声学造影积分指数（CSI）将患者分为A、B两组，比较两组的左室射血分数（LVEF），评估心肌灌注水平对心功能的影响；③根据心脏二维超声结果，比较两组患者术后6个月时左室舒张末直径（LVEDD）及LVEF的变化,进一步评估心肌灌注水平对左室重构的影响。结果： PCI后梗死相关血管TIMI血流均达III级。共152节段与梗死相关血管的再灌注有关。①MCS为0分的18节段中，2个（11.1%）WMS为1~2分；MCS为0.5分的30节段中16个（53.3 %）WMS为1~2分；MCS为1分的104节段中，82个（78.8%）WMS为1~2分；统计学分析显示，PCI后心肌灌注水平与室壁运动呈正相关（P<0.05）。②心肌灌注好的A组LVEF显著大于B组［(52.1±3.4)%，(47.2±2.9)%，P<0.05］。③术后6个月A组的LVEF及LVEDD均无明显变化，B组的LVEF较前有所下降［(47.2±2.9)%，(43.8±4.4)%，P<0.05］，LVEDD较前有所增加［(50.2±2.9) mm，(56.3±3.1) mm，P<0.05］。结论： AMI患者PCI后心肌灌注水平与心功能及左室重构有一定相关性，良好的心肌灌注在一定程度上可以抑制左室重构。

Abstract: AIM:To investigate the effect of different myocardial perfusion on cardiac function and left ventricular remodeling in acute myocardial infarction (AMI) patients with TIMI III after percutaneous coronary intervention (PCI). METHODS: Intravenous myocardial contrast echocardiography (MCE) and two-dimensional echocardiographic examination were performed in 36 patients. Myocardial contrast echocardiography score (MCS) and wall motion score (WMS) were assessed to evaluate the relationship between myocardial perfusion and ventricular segmental wall motion. Patients were divided into group A and group B according to the results of contrast score indexes (CSI). Left ventricular ejection fraction (LVEF) in all patients was measured to evaluate the effect of myocardial perfusion on cardiac function. Left ventricular end-diastolic diameter (LVEDD) and LVEF in all patients were measured 6 months after PCI to further evaluate the effect of myocardial perfusion on left ventricular remodeling. RESULTS: All infarct-related arteries were TIMI III after PCI and 152 myocardial segments were relative to the reperfusion of infarct-related arteries. Among the 18 myocardial segments with MCS as 0, 2 (11.1%) had WMS of 1-2. Among the 30 myocardial segments with MCS as 0.5, 16 (53.3%) had WMS of 1-2 and among the 104 myocardial segments with MCS as 1, 82 (78.8%) had WMS of 1-2. Statistical analysis showed that the level of myocardial perfusion was positively related to the ventricular segmental wall motion (P<0.05). The average LVEF in group A was significantly higher than in group B ［(52.1±3.4)% vs.(47.2±2.9)%, P<0.05］. Six months after PCI, the average LVEF and LVEDD did not change significantly in group A, whereas average LVEF decreased ［(47.2±2.9)% vs.(43.8±4.4)%, P<0.05］ and the average LVEDD ［(50.2±2.9) mm vs.(56.3±3.1) mm, P<0.05］ increased in group B. CONCLUSION: The level of myocardial perfusion is to some degree associated with cardiac function and ventricular remodeling. Myocardial perfusion could, to some extent, restrain ventricular remodeling.

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