ST段升高的不完全分辨率是急性心肌梗塞支架后短暂的微循环功能障碍的标志
Laurent J Feldman1, Pierre Coste, Alain Furber
1CHU Bichat-Département de Cardiologie, 46, rue Henri Huchard, 75018 Paris, France. laurent.feldman@bch.ap-hop-paris.fr
Circulation
|May 14, 2003
概括
在急性心肌梗塞 (AMI) 血管造形术后,ST段不完全分辨率 (STR) 表明严重的微循环功能障碍. 这种功能障碍与更广泛的心肌损伤有关,即使在成功插入支架后也是如此.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 微循环研究 微循环研究
背景情况:
- 对于急性心肌梗塞 (AMI) 的初级血管造形术后的ST段不完全分辨率 (STR) 与患者的不良结果相关.
- 微循环功能障碍是不良STR的潜在贡献者,但其严重程度和持续性需要进一步调查.
研究的目的:
- 为了确定初级血管造形术后不完整的STR是否意味着严重的微循环功能障碍.
- 评估STR对冠状动脉流速储备 (CVR) 和心肌损伤的影响.
主要方法:
- 在50名接受初级血管造形术和支架的AMI患者中使用了冠心内多普勒测速仪.
- 测量包括ST段分辨率,早期的缩逆流和冠状动脉流速储备 (CVR) 在支架前后.
主要成果:
- 患有<50%STR的患者表现出严重的微循环功能障碍的迹象,包括较高的逆行流量和较低的CVR.
- 在STR>=50%的患者中,CVR在支架后得到改善,但在STR<50%的患者中没有改善.
- 不完整的STR与左心室喷射率的减少和3个月内心脏病发作的大小有关.
结论:
- 在成功进行支架初级血管造形术后,不完整的STR (<50%) 作为AMI患者显著的,尽管可能是短暂的微循环功能障碍的标记.
- 这种功能障碍与更严重的心肌损伤有关.
相关概念视频
Blood Studies for Cardiovascular System I: Cardiac Biomarkers
Cardiac biomarkers are enzymes, proteins, and hormones released into the blood when cardiac cells are injured. They are powerful tools for triaging.
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
Acute Coronary Syndrome I: Introduction
Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
Acute Coronary Syndrome III: Diagnostic Studies
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
Ischemic Stroke ll: Pathophysiology
An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...
Transient Ischemic Attack l: Introduction
A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by a temporary, focal reduction in cerebral blood flow. Although symptoms resemble those of an ischemic stroke, the interruption in perfusion is short-lived and does not cause permanent infarction. TIAs are clinically important because they often serve as early warning events for future stroke.Mechanisms of Transient Cerebral IschemiaTransient cerebral ischemia may arise through several mechanisms. One...


