声学造影评价心肌梗死前心绞痛与心肌微循环及心功能的关系

Assessment of the Relatio nship between Preinfarction Angina and Myocardial Microcirculation after Revascu larization.

目的:应用经静脉心肌声学造影研究心肌梗死前心绞痛与心肌微循环、左室重构和收缩功能的关系。方法:研究对象为本院收治的29例急性心肌梗死患者,根据梗死前1周内有无发生心绞痛分成心绞痛组(A组,共17例)与无心绞痛组(B组,共12例)。采用PhilipsSonos5500超声诊断仪和S4探头进行超声检查和经静脉心肌声学造影显像。所有研究对象均行血管重建术,并于术后第5周复查二维超声。结果:①A组出现术后无再流现象的患者为3/17(17.6%)明显低于B组(8/12,66.7%),P<0.001。②A、B两组的左室舒张末期内径(EDD)在术后第1周差异无显著性。A组为52.2mm,B组为55.0mm,P>0.05,而在第5周A组的EDD(47.4mm)明显小于B组(55.5mm)(P>0.05)。A组的EDD逐渐减小(P<0.05),而B组的EDD无明显变化(P>0.05)。③A组的心脏射血分数(EF)显著改善,而B组的EF无明显变化(P>0.05)。结论:心肌梗死前心绞痛有利于血管重建术后心肌微循环和左室重构的改善,有助于左室功能的恢复。

Objective: To assess the relationship between preinfarction angina and myocardial microcircul ation and cardiac function after revascularization by intravenous myocardial con trast echocardiography(MCE).Methods:Twenty-nine pa-tients with acute myocardia l infarction were studied by means of MCE(Levovist),and harmonic power Doppler(P hilips Sonos5500)with S4probe after successful revascularization and the patient s were divided into group A(n=17,with prein-farction angina)and group B(n=12,wi thout preinfarction angina).Results:The incidence of no-reflow(myocardial con-trast score index<0.5)was lower in Group A than in Group B(17.6%vs66.7%,P<0.05). The end-diastolic dimension(EDD)was not significantly different in Group A and Group B in the first week after revascularization.The EDD decreased significantl y in the fifth week after revascularization in Group A,but it was not changed in Group B.The left ventricular e-jection fraction(EF)was improved in Group A,but not improved in Group B.Conclusions:Preinfarction angina is benefi-cial to mic rocirculation and left ventricular remodeling after reconstructive vascular oper ation,and it may help to improve recovery of cardiac function.