冠状动脉干预后异常冠状动脉流速储备与心脏标志物升高有关
J Herrmann1, M Haude, A Lerman
1Department of Cardiology, University Clinic Essen, Essen, Germany.
Circulation
|May 23, 2001
概括
支架后冠状动脉流速储备的减少往往表明微血管功能受损. 这项研究表明,减少rCVR与心脏酶升高有关,这表明冠状动脉手术期间栓塞引起的微血管损伤.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 微血管生理学 微血管生理学
背景情况:
- 冠状动脉干预后相对冠状动脉流速储量 (rCVR) 的降低与微血管功能障碍有关.
- 在这些情况下,心脏酶升高作为栓塞性心肌损伤标志物的发生率仍未得到充分研究.
研究的目的:
- 为了调查冠状动脉支架成功安置后心脏酶升高 (肌酸激酶和热素T) 的发生率.
- 为了确定术后rCVR与心脏酶升高之间的相关性.
- 为了确定rCVR的切割值来预测心肌损伤.
主要方法:
- 研究了55名患者,这些患者接受了圆满的冠状动脉支架,并进行了周围手术内冠状动脉多普勒分析.
- 在干预前和干预后24小时内测量了肌酸激酶 (CK) 和心脏热素T (cTnT) 水平.
- 进行了相关性和接收器运行特征 (ROC) 分析,以评估rCVR和酶升高之间的关系.
主要成果:
- 术后rCVR与cTnT (r=-0.498,P<0.001) 和CK升高 (r=-0.406,P=0.002) 独立相关.
- 一个rCVR切线0.78最好的区分cTnT和CK升高 (灵敏度83.3%/69.2%,特异性79.1%/76.2%).
- 与rCVR≥0.78 (两者为5.6%,P<0.001) 患者相比,rCVR<0.78的患者的cTnT (52.6%) 和CK (36.8%) 升高率显著更高.
结论:
- 心脏标记物升高在冠状动脉手术后经常出现,与减少rCVR相关.
- 在rCVR持续下降表明动血栓残渣的程序性栓塞.
- 微血管功能障碍和心肌损伤是干预后酶升高的潜在潜在机制.
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