急性心肌梗死冠状动脉侧支血流分数与左室功能关系的探讨

Correlation of Pressure-Derived Collateral Fractional Flow and Left Ventricular Function after Primary Percutaneous Intervention of Acute Myocardial Infarction

【目的】测定压力源性的冠状动脉侧支血流分数,评价其与传统的Rentrop分级间的相关性;并探讨该冠状动脉侧支血流分数与急性心肌梗死直接经皮冠状动脉介入治疗成功后左室功能变化之间的关系。【方法】29例急性心肌梗死患者行直接经皮冠脉介入术,术中用冠状动脉内压力导丝根据“病变远端楔嵌压/主动脉平均压”计算冠脉侧支血流分数,以0.24为截值将29例分为两组:A组(19例)冠状动脉侧支血流分数>0.24,B组(10例)侧支血流分数≤0.24。术后根据冠状动脉造影行Rentrop分级。采用Simpson's测左室射血分数、左室收缩及舒张末期容积,计算相关的容积指数。【结果】Rentrop分级与压力源性的冠状动脉侧支血流分数呈正相关性,该冠状动脉侧支血流分数同30d后左室射血分数呈正相关性。【结论】冠状动脉内压力源性的侧支血流分数可预测临床成功的直接经皮冠脉介入术后左室功能的恢复,并可对急性心肌梗死时侧支循环血流作出定量评价。

[Objective] 1.To investigate the con＇elation between pressure-derlved collateral fractional flow （PDCF） and Rentrop grade. 2.To evaluate the relation between PDCF and left ventricular recovery function after primary percutaneous coronary intervention （PCI）. [Method] The PDCF,determined by the ratio of P,/P., was measured in 29 patients with first acute myocardial infarction （AMI） treated by primary PCI whose onset was〈12hr. Sufficient collateral （Group A） was defined as PDCF〉0.24 and insufficient collateral （Group B） as PDCF≤0.24. Rentrop grade of collateral was evaluated by coronary angiography. Echocardiography was padormed on the 3a and 30^th day after PCI. Left ventricular ejection fraction, end systolic and diastolic volume, and the related indexes were obtained. [Result] Rentrop grade was significantly related to PDCF, but a wide range of PDCF was observed in patients with Rentrop grade≤1. [Conclusion] PDCF can predict left ventricular recovery after successful PCI, and evaluate the collateral flow mensurably with AMI.