摘要
目的 通过小剂量多巴酚丁胺负荷超声心动图 (dobutaminestressechocardiography ,DSE)评价急性心肌梗死患者存活心肌 ,探讨存活心肌对左室重构的影响。方法 入选 5 7例首次急性前壁心肌梗死且成功进行急诊冠状动脉介入治疗的患者。心肌梗死后 72h行小剂量 [5～ 10 μg (kg·min) ]DSE评价存活心肌。所有患者在心肌梗死后 2 4h、72h、4周及 12周定期随访超声心动图。根据DSE检查结果 ,将患者分为存活心肌组 (n =36 )和无存活心肌组 (n =2 1)。结果 存活心肌组患者左室舒张末期容量指数 (LVEDVI)无明显变化 ,左室收缩末期容量指数 (LVESVI)明显降低 ;无存活心肌组患者LVEDVI和LVESVI均逐渐增加。心肌梗死后 4周及 12周 ,存活心肌组患者LVEDVI、LVESVI明显低于无存活心肌组患者 [LVEDVI:梗死后 4周为 (6 4 90± 13 5 2 )ml m2 vs (90 75± 34 92 )ml m2 ,P <0 0 1;梗死后 12周为 (6 6 82± 9 78)ml m2 vs (10 2 71± 13 0 6 )ml m2 ,P <0 0 1。LVESVI:梗死后 4周为 (2 9 6 3± 30 36 )ml m2 vs (5 4 6 2± 37 90 )ml m2 ,P <0 0 5 ;梗死后 12周为 (2 8 4 5± 12 34)ml m2 vs (5 1 35±12 5 1)ml m2 ,P <0 0 5 ]。心肌梗死后 4周及 12周 ,存活心肌组患者左室射血分数 (LVEF)
Objective To evaluate whether the presence of residual viable myocardium, detected by low dose dobutamine stress echocardiography (DSE), would favorably influence left ventricular remodeling after acute myocardial infarction (AMI). Methods The patients with a first anterior wall AMI successfully treated with primary coronary angioplasty were studied by low dose DSE [5-10 μg/(kg·min) -1 ] 72 hour after AMI for identifying viable myocardium. Serial two-dimensional echocardiography was performed in all patients 24 hours, 72 hours, 4 weeks and 12 weeks after the attack of AMI. Results A total of 57 consecutive patients were divided in two groups based on the presence ( n =36) or absence ( n =21) of myocardial viability by DSE responses. Throughout the study period, left ventricular end diastolic volume index (LVEDVI) was stable in patients with myocardial viability, but left ventricular systolic volume index (LVESVI) decreased significantly. Patients without myocardial viability had a tendency to increase in both LVEDVI and LVESVI. LVEDVI and LVESVI in patients with myocardial viability were much less than that in patients without viability after the 4 th week [LVEDVI: (64.90±13.52) ml/m 2 versus (90.75±34.92) ml/m 2, P <0.01; LVESVI: (29.63±30.36) ml/m 2 versus (54.62±37.90) ml/m 2, P <0.05] and the 12 th week [LVEDVI: (66.82±9.78) ml/m 2 versus (102.71±13.06) ml/m 2, P <0.01; LVESVI: (28.45±12.34) ml/m 2 versus (51.35±12.51) ml/m 2, P <0.05] respectively. Left ventricular ejection fraction (LVEF)in patients with myocardial viability was significantly greater than that in patients without viability at the end of the 4 th week and the 12 th week respectively. Multivariate regression analysis identified myocardial viability and TIMI grade of infarct related artery as independent predictor of left ventricular remodeling. Conclusion Although good epicardial flow had been achieved after intervention therapy in all of AMI patients, some of them showed left ventricular remodeling i
出处
《中国介入心脏病学杂志》
2003年第4期203-206,共4页
Chinese Journal of Interventional Cardiology
关键词
急性心肌梗死
存活心肌
左室重构
超声心动图
小剂量
多巴酚丁胺
Myocardial Infarction
Ventricular Remodeling
Myocardial Viability
Dobutamine stress echocardiography
