慢性完全闭塞病变侧支循环与心功能恢复的关系

Relationship between collateral circulation and recovery of heart function in chronic total coronary occlusions

目的应用实时三维超声心动图(RT3DE),评价既往有心肌梗死病史的冠状动脉慢性完全闭塞病变(CTO)患者血运重建前后整体和局部心功能变化。方法选择38例既往有心肌梗死病史并血运重建成功的CTO患者,将其分为两组:A组为术前显示CTO处存在通畅的侧支或逆灌血流患者22例;B组为术前显示CTO处无侧支或逆灌血流患者16例。所有患者术前、术后6周均行RT3DE及二维超声心动图检查和室壁运动评价。结果A组患者术后6周LVEF由(53.8±5.6)%增加至(62.9±6.3)%,差异有统计学意义(P<0.05),左心室局部室壁运动显著改善(P<0.05),B组患者术后6周LVEF由(49.7±5.0)%增加至(51.0±4.8)%,差异无统计学意义。左心室局部室壁运动改善不明显。结论使用RT3DE评价既往有心肌梗死病史的CTO患者心脏功能和血运重建对于CTO存在良好侧支循环并保持通畅的患者,左心室整体和局部心功能明显提高。

Objective To assess the recovery of left ventricular ejection fraction（LVEF） and regional wall motion after successful recanalization of chronic total occlusions（CTO） by real-time three-dimensional echocardiography （RT3DE）. Methods Thirty-eight patients with previous myocardial infarction and a successfully recanalized CTO were included in the present prospective study. They were divided into 2 groups. Group A（22 cases） comprised the patients with collateral flow or retrograde flow in the territories of totally occluded vessel. Group B（16 cases） comprised the patients without collateral flow or retrograde flow in the territories of totally occluded vessel. PCI was performed in 14 patients and CABG in 24 patients. In all patients,RT3DE and two-dimensional echocardiography （2DE） were performed and wall motion was assessed before and 6 weeks following the procedure. Results In group A patients,the left ventricular ejection fraction （LVEF） increased from（53.8± 5.6）% to （62.9 ± 6.3）% （ P〈0.05 ）, while in group B patients, the LVEF increased,but not significantly,frorn（49.7±5.0）%to（51.0±4.8）%（ P 〉0.05）. The regional wall motion significantly improved in group A patients （ P 〈0. 05）, while it did not change in group B patients after revascularization in RT3DE（ P 〉0.05）. Conclusions Left ventricular function in patients with CTO can be feasibly and accurately evaluated by RT3DE. Revascularization may improve the regional and global left ventricular function in myocardial infarction patients having collateral circulation during follow-up.