梗死后心肌瘢痕组织与冠状动脉血流的关系

Relationship between myocardial scar tissue and coronary artery after infarction

目的探讨心肌梗死后心肌瘢痕组织与不同时期开通冠状动脉血流的关系。方法对急性心肌梗死患者进行经皮冠状动脉介入治疗(PCI),于发病后4、8、12周,应用同步十二导联心电图,观察相应导联碎裂QRS波群(fragmented QRS complexes,fQRS),应用心脏超声斑点追踪成像(speckle tracking imaging,STI)测量室壁运动应变比率及心脏超声心动图测定左室射血分数(LVEF),对心肌梗死后不同病理阶段开通冠状动脉血流的心肌瘢痕范围及心脏功能进行评价。结果联合fQRS及STI技术评价心肌梗死后心肌瘢痕,可使临床诊断心肌瘢痕的阳性预值明显提高,其敏感性和特异性分别为93.8%和98.7%;与择期PCI组相比,急诊PCI组fQRS阳性导联比率明显降低,室壁运动应变改善,LVEF提高(P均(0.05)。结论早期行PCI治疗开通冠状动脉血流可减少心肌瘢痕形成,保护心功能。

Objective To study the myocardial scar tissue after acute myocardial infarction （AMI）,and the curative effect of promoting coronary blood flow at different pathological stages. Method The patients with AMI were treated with percutaneous coronary intervention （PCI）. On the 4th,8th and 12th week,fragmented QRS complexes （fQES）,speckle tracking imaging （STI） and the strain ratio of ventricular wall movement were observed respectively by using twelve synchronous lead cardiogram,and LVEF was observed by using coronary angiography （CAG） at relevant infarction area. The range of myocardial scar tissue after AMI and heart function were evaluated. Results The evaluation of myocardial scar tissue and heart function by combining fQRS and STI improved the positive predictive value of myocardial scar diagnosis with the sensitivity as 93.8% and specificity is 98.7%. Compared with the selective PCI group,in the emergency PCI group positive lead ratio decreased significantly,ventricular strain was improved and LVEF increased （all P0.05）. Conclusion Early PCI for promoting coronary blood flow is propitious to inhibit the form of myocardial scar tissue and protect heart function.