Effects of Perindopril on Left Ventricular Remodeling and Osteopontin Expression in Rats With Myocardial Infarction

Objectives To observe the effects of perindopril on left ventricular remodeling and myocardial osteopontin expression in rats with myocardial infarction. Methods In this study male adult SD rats were randomly divided into 3 groups: sham-operation group, MI-saline group and MI-perindopril group. Left anterior descending artery was ligated to generate myocardial infarction. Perindopril (2 mg/kg body weight/day) was administered from the next day of MI. Four weeks later, left ventricular diameter (LVEDD and LVESD) and left ventricular ejection fraction was estimated with echocardiography, LVSP, LVEDP and±dp/dtmax was detected with hemodynamic measurement, cardiomyocyte diameter and interstitial fibrosis infiltration were evaluated with histological methods, and myocardium osteopontin protein expression level was detected with western blot. Results ①Compared with the sham-operation group, all rats with MI developed significant systolic and diastolic dysfunction, as was indicated by decreased LVEF, LVSP and±dp/dtmax, as well as increased LVEDP. ②Rats with MI showed significantly dilated left ventricles and higher ventricular weight / body weight ratio, significantly increased cardiomyocyte diameter and marked interstitial fibrosis in the non-infarction area. ③Perindopril treatment partly prevented cardiac dysfunction and left ventricular remodeling as indicated by the parameters mentioned above. ④No osteopontin protein was detected in myocardium of sham-operation rats. In rats with MI, high level osteopontin protein expression was significantly inhibited by perindopril treatment. Conclusions In rats with MI, perindopril treatment significantly prevented left ventricular remodeling and myocardium osteopontin protein expression.

Assessment of the Effect of Cardiomyocyte Transplantation on Left Ventricular Remodeling and Function in Post-Infarction Wister Rats by Using High-frequency Ultrasound

The effects of cardiomyocyte grafting on left ventricular （LV） remodeling and function in rats with chronic myocardial infarction were evaluated using high-frequency ultrasound. Chronic myocardial infarction was induced in 50 Wister rats by ligating the left anterior descending artery. They were randomized into two groups： a trial group that received neonatal rat cardiomyocyte trans- plantation （n=25） and a control group which were given intramyocardial injection of culture medium （n=25）. The left ventricular （LV） geometry and function were evaluated by high-frequency ultrasound before and 4 weeks after the cell transplantation. After the final evaluation, all rats were sacrificed for histological study. The results showed that 4 weeks after the cell transplantation, as compared with the control group, the LV end-systolic dimension, end-diastolic dimension, end-systolic volume and end-diastolic volume were significantly decreased and the LV anterior wall end-diastolic thickness, LV ejection fraction and fractional shortening were significantly increased in the trial group （P〈0.01）. Histological study showed that transplanted neonatal rat cardiomyocytes were found in all host hearts and identified by Brdu staining. It was suggested that transplantation of neonatal rat cardiomyocytes can reverse cardiac remodeling and improve heart function in chronic myocardial infarction rats. High-frequency ultrasound can be used as a reliable technique for the non-invasive evaluation of the effect of cardiomyocyte transplantation.

Viable Myocardium Impact on Left Ventricular Function after Late Revascularization of Infarct-related Artery in Acute Myocardial Infarction

Objectives The long-term benefit of late reperfusion of infarct-related artery （IRA） after acute myocardial infarction （AMI） is controversial, and the benefit mechanisms remain uncertain. Low dose dobutamine stress echocardiography （LDSE） can identify viable myocardium and predict improvement of wall motion after revascularization. Methods Sixtynine patients with first AMI who did not received early reperfusion therapy were studied by LDSE at 5 to 10 days after AMI. Wall motion abnormality and left ventricular size were measured at the same time. Successful PCI were done in all patients at 10 to 21 days after AMI onset. Patients were divided in two groups based on the presence or absence of viable myocardium. Echocardiography was repeated six months later. Results There were 157 motion abnormality segments. 89 segments （57%） were viable during LDSE. 26 patients （38%） with viability and 43 （62%） without. In viable group, left ventricular ejection fraction （LVEF） was increased （P 〈 0.05）, and left ventricular end systolic volume index （LVESVI） and wall motion score （WMS） were decreased （P 〈 0.05 and P 〈 0.01） significantly at 6 months compared with baseline. But in patients without viability, LVEF was decreased （P 〈 0.01）, and LVESVI and left ventricular end diastolic volume index （LVEDVI） were increased （P 〈 0.05） significantly after 6 months, and the WMS did not changed （P 〉 0.05 ）. LVEF increased （P 〈 0.05 ） and WMS decreased （P 〈 0.05） on LDSE during acute phase in patients with viability, but they were not changed in the nonviable group. Conclusions Late revascularization of IRA in patients with presence of viable myocardium after AMI is associated with long-term preservation left ventricular function and less ventricular remodeling. Improvement of left ventricular systolic function on LDSE indicates late phase recovery of left ventricular function after late revascularization.

Systematic Evaluation of Current Possibilities to Determine Left Ventricular Volumes by Echocardiography in Patients after Myocardial Infarction

Purpose: The aim of the present study was to evaluate the diagnostic accuracy for quantification of left ventricular (LV) volumes and LV ejection fraction (LVEF) with current echocardiographic methods of planimetry for analysis of LV remodeling after myocardial infarction in daily clinical routine. Methods: 26 patients were investigated directly after interventional therapy at hospital pre-discharge and at 6 month follow-up. Standardized 2D transthoracic native and contrast echocardiography were performed in all patients. Due to methodological aspects the results of LV volumes and LVEF using native echocardiography were compared to the results of LV opacification (LVO) imaging for analysis in mono-, bi- and triplane data sets using the Simpson’s rule. In addition corresponding multidimensional data sets were analyzed. Results: The assessment of LV volumes and LVEF is more accurate with contrast echocardiography. The comparison of LV volumes and LVEF shows significant increases using contrast echocardiography (p < 0.001). Larger left ventricular end-diastolic volumes (LVEDV) are measured at follow up (p < 0.05). Significant differences (p < 0.001) are found for the determination of LVEDV and LVEF relating to apical mono-, bi-, tri- and multiplane data sets. Standard deviations of the triplane approach, however, are significantly lower than using other modalities. Conclusion: Depending on the localization of the myocardial infarction LV volumes and LVEF are less reliably evaluated using the mono- or biplane approach. According to standardization and simultaneous acquisition of all LV wall segments the triplane approach is currently the best approach to determine LV systolic function. In addition, contrast echocardiography is indicated to improve endocardial border delineation in patients using the triplane or multiplane approach. To our knowledge the present study is the first systematic evaluation of all current possibilities for determination of LV volumes and LVEF by native and contrast echocardiography.

Frequency domain cardiography and radionuclide ventriculography for evaluation of left ventricular function in coronary artery disease

Fifty-six patients with chest pain underwent selective coronaryangiography,radionuclide ventriculography (RNV) and frequency domaincardiography (FCG) to evaluate left ventricular function in coronary artery dis-ease (CAD).The sensitivity,specificity and accuracy of FCG were 87.5%,77.8%and 82.9%,respectively,which were slightly less than those of RNV (92.5%,88.9% and 90.8%,respectively).The changes of FCG scores were negatively corre-lated with changes of LVEF (r=-0.586,P【0.01),and TS (r=-0.679,P【0.01).These results indicate that FCG may be useful for the evaluation of leftventricular function in patients with CAD.

Three hours continuous injection of adenosine improved left ventricular function and infarct size in patients with ST-segment elevation myocardial infarction

Background The definitive treatment for myocardial ischemia is reperfusion. However, reperfusion injury has the potential to cause additional reversible and irreversible damage to the myocardium. One likely candidate for a cardioprotection is adenosine. The present study aimed at investigating the effect of intravenous adenosine on clinical outcomes in patients with ST-segment elevation myocardial infarction （STEMI） undergoing primary percutaneous coronary intervention （PCI）. Methods Patients with STEMI within 12 hours from the onset of symptoms were randomized by 1：1：1 ratio to receive either adenosine 50μg-kg-1.min-1 （low-dose group, n=31）, or 70 μg.kg-1.min1 （high-dose group, n=32）, or saline 1 ml/min （control group, n=27） for three hours. Drugs were given to the patients immediately after the guide wire crossed the culprit lesion. Recurrence of no-reflow, TIMI flow grade （TFG） and TIMI myocardial perfusion grade （TMPG）, and collateral circulation were recorded. The postoperative and preoperative ST segment elevation sum of 18-lead electrocardiogram （ECG） and their ratio （STsum-post/STsum-pre） were recorded, as well as the peak time and peak value of CK-MB enzyme. Serial cardiac echo and myocardial perfusion imaging were performed at 24 hours and 6 months post-stenting. The primary endpoint was left ventricular function, and infarct size. The secondary end-point was the occurrence of cardiac and non-cardiac death, non-fatal myocardial infarction, and heart failure. Results A total of 90 STEMI patients were studied. No-reflow immediately after stent procedure was seen in 11 （35.5%） patients in the control group, significantly different from 6.3% in the low-dose group or 3.7% in the high-dose group （both P=0.001）. STsum-post/STsum-pre in the low-dose and high-dose groups was significantly different from the control group （low-dose group vs. control group, P=0.003 and high-dose group vs. control group, P=0.001）, without a dose-dependent pattern （P=0.238）. The peak value of CK-MB enzyme was significantly reduced in the high-dose group compared to the control group （P=-0.024）. Compared to the left ventricular ejection fraction （LVEF） in control group, LVEF in the low-dose group increased by 5.8% at 24 hours （P=0.012） and by 10.9% at 6 months （P=0,007）, LVEF in the high-dose group increased by 9.5% at 24 hours （P=0.001） and by 10.0% at 6 months （P=0.001）, respectively. Significant reduction of infarct size by 24.2% was detected in the high-dose group vs. low-dose or control groups （P=0.008）. There was no significant difference regarding secondary endpoints at 6 months among the treated groups. Cardiac function by NYHA classification in both the low-dose and the high-dose groups was improved significantly （P=0.013, P=0.016）. Conclusion Intravenous adenosine administration might significantly reduce the recurrence of no-reflow, with resultant improved left ventricular systolic function. High-dose adenosine was further associated with significant reduction of infarct size.

Effects of Late Reperfusion on Left Ventricular Function and Its Relationship With Viable Myocardium After Acute Myocardial Infarction in Patients With or Without Diabetes

Objectives To compare the different effects of late successful reperfusion with PCI on left ventricular function and its relationship with viable myocardium after acute anterior wall myocardial infarction in patients with or without diabetes. Methods A total of 125 consecutive subjects with acute anterior wall myocardial infarction were selected, and divided into diabetes mellitus （DM） group （ n = 43） and Non-DM group （ n = 82） according to WHO diabetes diagnosis criteria. All patients received successful PCI at 12 ± 8 days from onset. Ischemic viable myocardium was detected with low-dose dobutamine echocardiography, and left ventricular function and wall motion abnormality were also assessed with echocardiography before PCI. The data of clinical manifestations and angiograms before and after PCI were analyzed. Levels of creatinine kinase-MB （CK-MB）, and troponin T （TnT） before PCI, 6 hours and 24 hours after PCI were assessed. All patients received clinic and echocardiography follow-up for 6 months. Results Higher rate of TIMI 2 flow, and lower rate of TIMI 3 flow in DM group were demonstrated immediately after PCI, and the rate of serum CK-MB and/or TnT levels were higher in DM group, compared with Non-DM group（P 〈 0.05）. 63% of DM patients and 56% of non-DM patients had viable myocardium before PCI（ P 〉 0. 05）. There were no significant differences of left ventricular ejection fraction （LVEF）, left ventricular end diastolic volume index （LVEDVI）, left ventricular end systolic volume index （LVESVI）, and wall motion score （WMS） between two groups at baseline before PCI（P 〉 0.05）. After six months, WMS was decreased and LVEF was increased in Non-DM group, but the WMS and the LVEF did not changed, and the LVEDVI was increased in DM group compared with baseline; the LVEDVI, LVESVI, LVEF, and WMS were significantly different between two groups （P 〈 0.05 or P 〈 0. 01 ）. Conclusions Compared with non-diabetics, delayed successful revascularization with PCI in diabetics patient with acute myocardial infarction has less benefitial effect on the improvement of late phase left ventricular function, and it may be because the insufficient reperfusion or reperfusion injury to myocardium but not the viable myocardium contributing to the poor result. （S Chin J Cardiol 2009; 10（4） ： 196 -203）

BENEFICIAL EFFECTS OF NTG ON LEFT VENTRICULAR VOLUMES AND SYSTOLIC FUNCTION IN PATIENTS WITH MYOCARDIAL INFARCTION

The effect of sublingual administration and intravenous drip of nitroglycerin (SLNTG and IVNTG) on left ventricular volumes (LVVs) were studied and systolic function was quantitatively assessed with two-dimensional echocardiography (2DE) in 28 patients with myocardial infarction (MI), including 13 cases without heart failure (MI-NHF) in one group and 15 with heart failure (MI-HF) in another. The results showed that after SLNTG and IVNTG in both groups the heart rate (HR) increased significantly (P< 0.05-0.001); the systolic blood pressure (SBP) decreased significantly (P< 0.05-0.001); the diastolic blood pressure (DBP) was not significantly changed (all P>0.05); the left ventricular end-diastolic and end-systolic volumes (EDV and ESV) both significantly reduced [EDV: decreased by 5.8-11.6% (-13.2-19.0 ml), P< 0.05-0.001; ESV: decreased by 9.6-16.6% (-8.6-17.3 ml), P< 0.05-0.001)1; the left ventricular ejection fraction (LVEF) all significantly elevated (increased by 6.6%-9.4% (3.2%-3.4%), P < 0.05-0.001] except in MI-NHF group after IVNTG; the segmental EF of normal and hypokinetic segments also significantly increased (P<0.05-0.001). The results suggest that NTG could beneficially reduce left ventricular EDV and ESV; and improve or strengthen its global and segmental systolic function in MI patients, particularly noticeable in patients with heart failure.

平板运动负荷超声心动图评价急性心肌梗死患者PCI术后左室功能的价值

目的:分析平板运动负荷超声心动图评价急性心肌梗死患者经皮冠状动脉介入治疗(PCI)术后左室功能的价值。方法:选取2020年1月—2022年12月于肇庆市广宁县人民医院行急诊PCI术的急性心肌梗死患者150例作为研究对象,分别采用常规心电图、动态心电图、平板运动负荷超声心动图检测患者术后1个月左室功能,以临床综合检查结果为“金标准”,比较三种检查方式的诊断价值。结果:临床综合检查显示,150例开展急诊PCI术治疗的急性心肌梗死患者中有31例发生左室功能异常,占比20.67%。动态心电图诊断PCI术后左室功能异常的灵敏度、特异度、准确率、阳性预测值、阴性预测值高于常规心电图,平板运动负荷超声心动图诊断PCI术后左室功能异常的灵敏度、特异度、准确率、阳性预测值、阴性预测值高于动态心电图与常规心电图,差异有统计学意义(P<0.05)。结论:平板运动负荷超声心动图评价PCI术后左室功能的价值较高。

氨基末端脑钠肽前体、左室射血分数及心电图碎裂QRS波群与急性心肌梗死患者不良预后的相关性研究

目的:探究氨基末端脑钠肽前体(NT-proBNP)、左室射血分数(LVEF)、心电图碎裂QRS波群(fQRS)与急性心肌梗死(AMI)患者不良预后的关系。方法:采用巢式病例对照研究方法,选取2021年1月-2023年1月于河池市第三人民医院行经皮冠状动脉介入治疗(PCI)的AMI患者96例作为研究对象,依据术后6个月是否发生主要心血管不良事件进行分组,将预后不良的患者纳入预后不良组,随后在研究队列人群中按照1∶2频数配比纳入预后良好的患者为预后良好组。收集并分析患者的临床信息,采用Logistic回归模型分析NT-proBNP、LVEF及fQRS与AMI预后不良的相关性。结果:96例AMI患者术后随访6个月发现预后不良患者19例(19.78%)。多因素Logistic回归分析结果提示,NT-proBNP水平上升、LVEF降低、发生fQRS是AMI患者不良预后的影响因素(P<0.05)。结论:NT-proBNP、LVEF、fQRS是AMI患者不良预后的影响因素,在预测心血管不良事件及预后具有重要意义。

基于7.0T心血管磁共振探究苍艾挥发油对高原心功能损伤大鼠的治疗作用

目的 基于7.0T心血管磁共振(CMR)探索苍艾挥发油(CAVO)对青藏高原低压低氧环境下心功能损伤模型大鼠的心脏保护作用。材料与方法 将40只SD大鼠随机分为正常组、高原模型组、CAVO治疗组和红景天治疗组,每组10只。除正常组外,其余各组大鼠从平原(海拔500 m)转运至青藏高原(海拔4 250 m)饲养2个月后,使用相应药物灌胃给药14 d。使用7.0T高场强CMR测量左心室功能,并采用组织追踪技术分析心肌应变。使用HE染色观察心肌细胞形态,Masson染色观察心肌间质纤维化,小麦胚芽凝集素染色观察心肌细胞肥大情况,透射电镜观察各组线粒体形态学改变。检测血清中肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶、心肌肌钙蛋白T、超氧化物歧化酶、丙二醛和谷胱甘肽过氧化物酶水平。使用流式细胞术检测细胞内活性氧水平。结果 CAVO治疗组大鼠左心室射血分数高于高原模型组[(66.61±1.38)%比(60.94±3.21)%;t=3.969,P=0.032)],左心室整体环向应变高于高原模型组(-25.68±1.30比-22.84±1.17;t=3.967,P=0.003);HE、Masson和小麦胚芽凝集素染色显示高原模型组心肌细胞出现肥大、坏死以及间质纤维化,超微结构破坏,CAVO治疗后有所改善。CAVO治疗组大鼠血清中心肌肌钙蛋白T水平比高原模型组明显下降[(314.03±20.05)pg/ml比(518.30±18.13)pg/ml;t=13.090,P=0.001]。结论 CAVO治疗可减轻高原低压缺氧引起的心脏损伤,其效果可通过7.0T高场强CMR动态、无创性检测。

替格瑞洛对AMI后小鼠左心室重构及心功能的影响

目的探究替格瑞洛对急性心肌梗死(acute myocardial infarction,AMI)后小鼠左心室重构及心功能的影响。方法8周龄雄性C57BL/6小鼠随机分为5组:假手术组(Sham组)、AMI组、替格瑞洛治疗组、替格瑞洛预处理组和替格瑞洛预处理+治疗组。除Sham组外,其他各组通过结扎左前降支冠状动脉建立AMI模型。替格瑞洛治疗组在造模后给药,预处理组在造模前给药,预处理+治疗组在造模前后给药。比较各组左心室功能[左心室短轴缩短率(left ventricular fractional shortening,LVFS)、左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)和左心室收缩末期内径(left ventricular end-systolic diameter,LVESD)]、炎症标志物[白细胞介素-6(interleukin-6,IL-6)和肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)]、心脏指数以及血清心房钠尿肽(atrial natriuretic peptide,ANP)和脑钠尿肽(brain natriuretic peptide,BNP)mRNA表达水平。结果Sham组、替格瑞洛治疗组和替格瑞洛预处理+治疗组的LVFS[(42.12±5.20)%、(39.63±5.75)%和(41.72±6.31)%]高于AMI组的(33.98±5.21)%,差异有统计学意义(P<0.05),而LVEDD和LVESD则低于AMI组[(3.59±0.61)mm、(4.03±0.65)mm和(3.96±0.73)mm vs.(4.79±0.74)mm;(2.13±0.40)mm、(2.39±0.56)mm和(2.29±0.48)mm vs.(2.93±0.54)mm],差异均有统计学意义(F=3.894,3.471,P<0.05)。Sham组、替格瑞洛治疗组和替格瑞洛预处理+治疗组炎症因子IL-6和TNF-α水平低于AMI组[(110.50±25.34)pg/mL、(202.28±55.24)pg/mL和(189.49±43.31)pg/mL vs.(359.48±80.10)pg/mL;(24.59±6.95)pg/mL、(51.28±14.03)pg/mL和(47.49±11.16)pg/mL vs.(81.92±15.55)pg/mL],差异均有统计学意义(P<0.001)。Sham组、替格瑞洛治疗组和替格瑞洛预处理+治疗组的心脏指数分别为(4.90±0.84)、(5.44±0.90)和(5.31±0.84)低于AMI组的(6.39±1.29),差异有统计学意义(F=3.985,P<0.05)。替格瑞洛预处理组的心脏指数为(6.21±1.04),与AMI组比较,差异无统计学意义(P>0.05)。Sham组、替格瑞洛治疗组和替格瑞洛预处理+治疗组ANP的mRNA表达水平低于AMI组[(1.22±0.34)、(1.83±0.54)、(1.80±0.57)vs.(2.66±0.69);(1.08±0.24)、(1.48±0.56)、(1.38±0.49)vs.(2.45±0.75)],差异均有统计学意义(P<0.001)。结论替格瑞洛能够改善AMI后小鼠的左心室功能,并且增强心脏收缩功能,减小心室扩张程度,有效地减轻心肌炎症反应和降低心脏负荷。

依洛尤单抗对急性广泛前壁心肌梗死患者PCI术后血脂及左心室功能的影响

目的探讨依洛尤单抗对急性广泛前壁心肌梗死经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后血脂和左心功能的影响。方法回顾性分析2021年1月至2023年7月于聊城市人民医院就诊的急性广泛前壁心肌梗死并行急诊PCI的患者52例,根据患者的术后的调脂方案分为两组,其中单纯服用瑞舒伐他汀者为对照组,共24例;联合瑞舒伐他汀和依洛尤单抗治疗者为观察组,共28例。分别于术前及术后6个月测定患者血总胆固醇(TC),甘油三酯(TG),低密度脂蛋白(LDL),高密度脂蛋白(HDL),C反应蛋白(CRP),B型钠尿肽(BNP)。行心脏彩超检查测定左室射血分数(LVEF),左室舒张末内径(LVEDD)。结果术后6个月,与对照组相比,观察组TC(3.28±0.73mmol/L vs 4.45±0.99mmol/L,t=-4.90,P<0.001)、TG(1.09±0.33mmol/L vs 1.61±1.07mmol/L,t=-2.44,P=0.02)、LDL(1.18±0.12mmol/L vs 2.05±0.35mmol/L,t=-11.59,P<0.001)、BNP(263.57±119.12pg/mL vs 575.58±219.99pg/mL,t=-6.21,P<0.001)、CRP(1.19±1.03mg/L vs 1.74±0.66mg/L,t=-2.23,P=0.02)明显降低,HDL(1.97±0.34mmo/L vs 1.66±0.29mmol/L,t=3.472,P=0.001)明显升高,LVEDD(35.57±2.83mm vs 40.83±4.35mm,t=-5.074,P<0.001)明显缩小,LVEF[(59.36±6.92%)vs(52.50±7.96%),t=3.32,P=0.002]明显升高。结论在急性广泛前壁心肌梗死中联合应用依洛尤单抗和他汀类药物可进一步显著降低患者的血脂和炎症水平,而且能进一步改善患者左心室功能。

STEMI合并心衰患者急诊PCI术后早期应用沙库巴曲缬沙坦对心功能和左心室重构的影响

目的探究STEMI合并心衰患者急诊PCI术后早期应用沙库巴曲缬沙坦对心功能和左心室重构的影响。方法选取2021年10月至2022年4月在我院心内科接受PCI治疗的130例STEMI合并心衰患者,按照随机数字表法分为对照组和观察组,每组各65例。PCI术后24 h内,对照组给予依那普利片治疗,观察组给予沙库巴曲缬沙坦治疗。观察两组患者PCI术后即刻及术后4周、24周血清N端B型脑钠肽前体(NT-proBNP)水平;左室收缩末期容积(LVESV)、左室射血分数(LVEF)和左室舒张末期容积(LVEDV)等心功能指标。术后4周、24周6分钟步行试验。两组不良心血管事件(MACE);死亡、再梗死、门诊心衰或心衰住院、恶性心律失常或中风等预后情况;不良反应。结果术后4周、24周,观察组血清NT-proBNP较对照组降低(P<0.05)。术后4周、24周,观察组LVEF较对照组升高(P<0.05),观察组LVESV和LVEDV较对照组降低(P<0.05)。观察组术后4周、24周的6分钟步行试验距离较对照组增多(P<0.05)。观察组心衰或心衰住院、恶性心律失常、死亡发生率低于对照组(P<0.05)。两组再梗死、中风发生率及治疗期间不良反应发生率差异无统计学意义(P>0.05)。结论沙库巴曲缬沙坦可改善行PCI的STEMI合并心衰患者的左室收缩功能,抑制左心室重构,降低NT-proBNP水平。

A comparative study on the effects of low dose of tPA and different regimens of intravenous urokinase in acute myocardial infarction

Objective To compare the effects of low dose of recombinant tissue type plasminogen activator(tPA) with those of conventional dose of urokinase (UK) and assess the influence of different regimens of intravenous UK in patients with acute myocardial infarction (AMI). Methods Eighty patients with AMI were randomized to 50 mg of tPA (Group Ⅰ; n=26) using an accelerating approach or 1.0-1.5 million U of UK (Group Ⅱ; n=54). UK was administered as a single bolus injection of whole dose (Group Ⅱa; n=26) or half dose bolus injection followed by half dose infusion (Group Ⅱb; n=28). All patients underwent coronary arteriography 90 min after the initiation of intravenous thrombolysis, and the infarct related coronary artery (IRA) patency was evaluated. Cardiac events during hospitalization were recorded and predischarge left ventricular function was determined by two dimensional echocardiography. Results The IRA patency rate was significantly higher in Group Ⅰ (88.4%) than in Group Ⅱ (53.7%) (P<0.01). Group Ⅰ patients had less cardiac events during hospitalization (11.5% vs 33.3%) and greater improvement in left ventricular function than Group Ⅱ patients. However, these angiographic, left ventricular functional and prognostic parameters did not significantly differ between Group Ⅱa and Group Ⅱb. Conclusions Thrombolysis after AMI with low dose of intravenous tPA exerts better angiographic and clinical effects than that with conventional dose of UK. The thrombolytic effects of UK were not affected by different regimens of intravenous administration of the agent.

三维斑点追踪成像技术对心肌梗死患者PCI后发生MACE的预测效能

目的 探讨三维斑点追踪成像技术(3D-STI)对心肌梗死患者经皮冠状动脉介入治疗(PCI)后发生主要不良心血管事件(MACE)的预测效能。方法 回顾性选择2019年6月至2021年7月于浙江大学医学院附属金华医院接受PCI且随访至2022年8月的心肌梗死患者86例,根据随访结果是否发生MACE分为观察组与对照组,比较两组患者左心室整体纵向应变(GLS)、整体环向应变(GCS)、整体径向应变(GRS)、整体面积应变(GAS)、左心室射血分数(LVEF)。采用Pearson相关分析3D-STI参数与MACE的相关性。采用ROC曲线分析GLS、GCS、GRS、GAS、LVEF参数预测MACE发生的AUC值、灵敏度、特异度。结果 发生MACE(观察组)18例。观察组术前GLS、GCS、GRS、GAS绝对值低于对照组,差异均有统计学意义(均P<0.05)。心肌梗死患者PCI术后1、6、12个月的GLS、GCS、GRS、GAS、LVEF绝对值值逐渐增高,且均高于术前,差异均有统计学意义(均P<0.05)。Pearson相关分析显示,GLS、GCS、GRS、GAS、LVEF与MACE均呈负相关(均P<0.05)。ROC曲线分析显示,3D-STI联合参数预测MACE的预测效能高于单一指标预测,AUC值0.944,灵敏度0.889,特异度0.897。结论 心肌梗死患者PCI术前3D-STI检测有助于预测术后MACE。

无创左室压力-应变环评估急性心肌梗死患者经皮冠状动脉介入术前后左心功能及左室重构的价值

目的探讨基于无创左室压力-应变环(LV-PSL)技术评估急性心肌梗死(AMI)患者经皮冠状动脉介入(PCI)术前、后的心肌做功情况及左室重构的临床价值。方法选择70例AMI患者(冠心病组)及同期体检的50例健康成人(对照组)。比较对照组和冠心病组术前、术后7 d检查常规超声心动图指标、左室整体纵向应变(GLS)和左室心肌做功指标[整体做功指数(GWI)、整体做功效率(GWE)、整体有用功(GCW)、整体无用功(GWW)]的差异。冠心病组患者进一步根据冠脉造影结果分为冠心病单支组34例和冠心病多支组36例,对比两组上述指标的差异。分析左室心肌做功指标与GLS、常规超声心动图指标的相关性。结果冠心病组术前、术后7d左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)、GWW均高于对照组,左室射血分数(LVEF)、GWI、GWE、GCW、GLS均低于对照组,差异均有统计学意义(P<0.05)。冠心病组术后7 d LVESV、LVEDV、GWW均低于术前,LVEF、GWI、GWE、GCW、GLS均高于术前,差异均有统计学意义(P<0.05)。冠心病多支组术前及术后7 d LVESV、LVEDV、GWW均高于冠心病单支组,LVEF、GWI、GWE、GCW、GLS均低于冠心病单支组,差异均有统计学意义(P<0.05)。相关性分析显示,GWW与GLS、LVEF均呈负相关,GWE、GCW、GWI与GLS、LVEF均呈正相关(P<0.001)。结论LV-PSL技术在评估AMI患者PCI术前、后左心功能及左室重构方面具有较好的应用价值,为临床急性心肌梗死患者经皮冠状动脉介入术术后提供了一种无创、有效的评估新方法。

基于赋能理论的分阶段管理干预对急性心肌梗死患者心功能和自我管理效能的影响

目的:分析赋能理论下的分阶段管理对急性心肌梗死(AMI)患者心功能、自我管理效能的影响。方法:选择2020年4月-2022年12月在我院首次诊断为AMI并行经皮冠状动脉介入术(PCI)的110例患者作为研究对象,根据随机数字表法均分为对照组(55例,采用常规干预方式)与观察组(55例,基于赋能理论的分阶段管理干预)。对比两组患者疗效及干预前后心功能、冠心病自我管理行为量表(CSMS)、一般自我效能感量表(GSES)、中国心血管患者生活质量评定问卷(CQQC)评分、主要不良心血管事件(MACE)及再入院发生率。结果:与对照组比较,观察组干预后总有效率(72.73%比89.09%)、左室射血分数(LVEF)[(52.67±1.56)%比(56.80±1.10)%]、CSMS[(87.29±11.02)分比(101.45±17.01)分]、GSES[(24.67±3.66)分比(29.24±4.83)分]、CQQC[(80.18±14.25)分比(104.00±20.95)分]评分均显著升高,P<0.05或<0.01;左心室舒张末期容积(LVEDV)[(133.58±4.43)ml比(117.26±4.26)ml]、左心室收缩末期容积(LVESV)[(64.49±2.48)ml比(55.13±2.58)ml]和再入院率(14.55%比1.82%)显著降低,P<0.05或<0.01。两组MACE发生率无显著差异(χ^(2)=3.782,P=0.052)。结论:基于赋能理论的分阶段管理能够显著提高AMI患者的治疗效果,同时改善患者心功能、提高自我管理能力、自我效能感和生活质量,并降低再入院率。

血清3-NT、cTnT、心功能与STEMI患者介入治疗后左心室重构的关系

目的 探讨血清3-硝基氨基酸(3-NT)、心肌肌钙蛋白T(cTnT)、心功能与急性ST段抬高心肌梗死(STEMI)患者介入治疗后左心室重构的关系。方法 选取85例STEMI患者,按介入治疗后是否出现左心室重构分为观察组(n=42)和对照组(n=43)。比较两组介入治疗前后血清3-NT、cTnT水平及介入治疗1周后心功能情况。分析STEMI患者介入治疗后左心室重构的影响因素,以及各因素对发生左心室重构的预测价值。结果 观察组体质指数、收缩压、舒张压、空腹血糖、总胆固醇、低密度脂蛋白胆固醇、同型半胱氨酸水平明显高于对照组(P<0.05)。与治疗前相比,治疗后两组血清3-NT、cTnT升高,且观察组高于对照组(P<0.05)。PCI术治疗1周后,观察组左心室舒张期末容积(LVEDV)高于对照组,左室射血分数(LVEF)低于对照组(P<0.05)。血清3-NT与cTnT、LVEDV呈正相关,3-NT与LVEF呈负相关(P<0.05)。总胆固醇、低密度脂蛋白胆固醇、3-NT是STEMI患者PCI术后发生左心室重构的危险因素(P<0.05)。3-NT对预测左心室重构具有良好的效能(P<0.05)。结论 3-NT是STEMI患者PCI术后发生左心室重构的危险因素,其对预测左心室重构具有良好的效能。

实时三维超声心动图在急性心肌梗死经皮冠状动脉介入术后左心室容积及收缩功能评估中的应用价值

目的探究实时三维超声心动图(RT-3DE)在急性心肌梗死(AMI)经皮冠状动脉介入术(PCI)后左心室容积及收缩功能评估中的应用价值。方法选取2022年1—6月景德镇市第二人民医院收治的30例AMI并行PCI的患者作为实验组,并根据年龄和性别匹配30例心血管系统无明显异常的患者作为对照组。所有患者均行常规二维超声心动图(2DE)及RT-3DE检查,比较实验组术前及术后1、3个月、对照组左心室收缩功能。以心脏磁共振成像(CMRI)为金标准,分析2DE、RT-3DE对AMI后左心室重构的诊断效能。结果术后1、3个月,实验组心室舒张末期容积(LVEDV)和左心室收缩末期容积(LVESV)均小于术前,左心室射血分数(LVEF)高于术前,且术后3个月LVEDV和LVESV均小于术后1个月,LVEF高于术后1个月,差异有统计学意义(P<0.05);术前及术后1、3个月,实验组LVEDV、LVESV均大于对照组,LVEF低于对照组,差异有统计学意义(P<0.05)。RT-3DE分析时间为(325.85±18.23)s,短于2DE的(428.95±26.68)s,差异有统计学意义(P<0.05)。以CMRI为检查的金标准,左心室重构19例,左心室正常构型11例。RT-3DE对左心室重构的诊断灵敏度、特异度、准确度均高于2DE,差异有统计学意义(P<0.05)。结论RT-3DE对AMI患者PCI后左心室容积及收缩功能的评估更为准确,分析时间更短,有助于疗效评估及随访,具有一定的临床价值。