慢性冬眠心肌血运重建后室壁运动功能恢复程度的观察

Recovery degree of regional wall motion abnormalities in hibernating myocardium of coronary heart disease after complete revascularization

目的:观察冠心病慢性冬眠而无梗死的心肌在完全血运重建后收缩功能的恢复情况。方法:选择23例具有慢性冬眠心肌特征的冠心病患者,男16例,女7例,年龄61±9岁。有前降支(LAD)、右冠状动脉(RCA)病变者分别为14例、9例,病变血管狭窄率为(95.2±4.1)％、TIMI血流2.1±0.7级。应用PTCA及支架术进行血运重建,术后无残余狭窄,且TIMI血流完全恢复正常;对有冬眠心肌患者进行6个月随访,应用二维超声心动图室壁运动障碍积分(WMAS)衡量冬眠心肌功能恢复情况。结果:术前轻中度与重度运动障碍的左室壁心肌节段的WMAS分别为6.9±3.5和13.9±4.4,术后6个月分别为0.6±0.4和2.9±2.1(P<0.01);术前LAD和RCA供血区左室壁心肌节段中的WMAS分别为14.2±4.3和7.0±3.2,术后分别为3.1±2.0和0.4±0.5(P<0.01)。结论:严重缺血但无梗死的慢性冬眠心肌在完全血运重建术后功能有显著改善,但不能完全恢复,且其功能的恢复受供血血管及术前血供减少程度的影响。

Objective: This study was designed to evaluate the recovery degree of regional wall motion abnormalities (RWMA) in hibernating myocardium of coronary heart disease (CHD) after complete revascularization. Methods: Twenty-three patients (16 male, 7 female, age at 61±9 years) with hibernating but without infarcted myocardium were included in this study. There were 14, 9 cases with lesion in LAD, RCA respecrively, complicated with stenosis of 95. 2±4.1% and TIMI flow of 2. 1±0. 7 degrees. Complete revascularization was achieved by PTCA plus stenting. Wall motion abnormalities score (WMAS) by echocardiography was employed to assess the change of regional myocardial function after 6 months. Results: In the segments with mild-moderate and severe RWMA, WMAS was 6. 9±3. 5 and 13. 9±4. 4 respectively before revascularization, and become 0. 6±0. 4 and 2. 9±2. 1 respectively after revascularization (P<0. 01). In regions supplying by LAD and RCA, WMAS was 14. 2 ±4. 3 and 7. 0±3. 2 respectively before revascularization, and become 3. 1±2. 0 and 0. 4±0. 5 respectively after revascularization (P< 0. 01). Conclusion:Recovery of regional wall motion abnormalities can be significantly ameliorated,but can't complete recovery by complete revascularization in hibernating myocardium of CHD.