摘要
目的应用微循环阻力指数(IMR)、心肌声学造影(MCE)、TIMI心肌灌注帧数(TMPFC)评价急性前壁心肌梗死患者经皮冠状动脉支架植入术(PCI)后微循环状态,及其对心肌微循环的评价效果和临床预后的关系。方法2016年1月至2018年6月接受急诊PCI的急性前壁ST段抬高型心肌梗死(STEMI)的患者共88例。完善IMR、MCE、TMPFC检查以了解患者微循环状态,常规收集患者临床及介入各项指标,随访6个月主要不良心脑血管事件(MACCE)的发生情况。结果TMPFC、和心肌血管床容积(A)、心肌血流速度(β)、心肌血流量(MBF)、TIMI 3级、TIMI心肌灌注分级(TMPG)3级同IMR具有相关性(P均<0.05)。IMR、TMPFC、A、β、MBF、TMPG 3级同脑钠肽(BNP)、PCI后及6个月左室射血分数(LVEF)具有相关性(P均<0.05)。多元Logistic回归分析提示IMR(OR=1.292,95%CI:1.108~1.506,P=0.001)、TMPFC(OR=1.030,95%CI:1.008~1.053,P=0.006)和MBF(OR=1.025,95%CI:1.002~1.324,P=0.005)为前壁STEMI患者术后6个月MACCE发生的独立危险因素。结论IMR、MBF和TIMI心肌灌注帧数同急性ST段抬高型心肌梗死患者急诊PCI后心功能明显相关,同时也是急性心肌梗死6个月主要心脑血管不良事件发生的独立危险因素。心肌声学造影和TIMI心肌灌注帧数计数应更广泛地应用于心血管疾病的诊断和治疗。
Objective To discuss the effectiveness of index of microcirculatory resistance(IMR),myocardial contrast echocardiography(MCE)and TIMI myocardial perfusion frame count(TMPFC)in the review of microcirculation status and prognosis in patients with acute anterior ST-segment elevation myocardial infarction(AA-STEMI)after percutaneous coronary intervention(PCI).Methods AA-STEMI patients(n=88)with acute anterior ST-segment elevation myocardial infarction(AA-STEMI)received emergency PCI were chosen from Jan.2016 to June 2018.The microcirculation status was reviewed after using IMR,MCE and TMPFC.The clinical and PCI indexes were conventionally collected from the patients.The incidence of major adverse cardiovascular and cerebrovascular events(MACCE)were followed up for 6 months.Results TMPFC,myocardial vascular bed volume(A),myocardial flow velocity(β),myocardial blood flow(MBF),TIMI grade 3 and grade 3 of TIMI myocardial perfusion grade(TMPG)were correlated to IMR(all P<0.05).IMR,TMPFC,A,β,MBF and TMPG grade 3 were correlated to BNP and LVEF after PCI and after 6 months(all P<0.05).The results of Logistic regression analysis indicated that IMR(OR=1.292,95%CI:1.108~1.506,P=0.001),TMPFC(OR=1.030,95%CI:1.008~1.053,P=0.006)and MBF(OR=1.025,95%CI:1.002~1.324,P=0.005)were independent risk factors of MACCE incidence in AA-STEMI patients after PCI for 6 months.Conclusion IMR,MBF and TMPFC are significantly correlated to heart function in AA-STEMI patients after PCI,meanwhile they are also independent risk factors of MACCE incidence after PCI for 6 months.MCE and TMPFC can be widely used in the diagnosis and treatment of cardiovascular diseases.
作者
赵甲彧
傅向华
朱男
张芳
刘雅婷
Zhao Jiayu;Fu Xianghua;Zhu Nan;Zhang Fang;Liu Yating(Department of Cardiology,First Hospital of Qinhuangdao City,Hebei Province,Qinhuangdao 066000,China;不详)
出处
《中国循证心血管医学杂志》
2020年第12期1470-1474,共5页
Chinese Journal of Evidence-Based Cardiovascular Medicine
基金
河北省秦皇岛市重点研发计划科技支撑项目(201805A059)。
关键词
急性心肌梗死
微循环阻力指数
声学造影
TIMI血流灌注帧数
主要不良心脑血管事件
Acute myocardial infarction
Index of microcirculatory resistance
Contrast echocardiography
TIMI myocardial perfusion frame count
Major adverse cardiovascular and cerebrovascular events
