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非 perfused 心肌体积和表面积与冠状动脉微栓塞的左心室性能之间的关系

Nasser M Malyar¹, Lilach O Lerman, Mario Gössl

¹Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA.

|September 29, 2004

概括

冠状动脉微栓塞导致左心室功能障碍. 这种功能障碍是由非透的心肌的表面积而不是体积决定的. 这一发现对于了解此类事件后心脏损伤至关重要.

科学领域:

心脏病学心脏病学
心血管研究研究心血管研究
心肌梗塞的心脏病发作

背景情况:

在表心动脉封闭后的左心室 (LV) 功能障碍与非 perfused 心肌 (NPM) 体积相关.
冠状动脉微栓塞 (ME) 与NPM体积相比,导致不成比例地更大的LV功能障碍.

研究的目的:

调查NPM的总表面积 (SA) 或总体积是否是ME后LV功能障碍的主要决定因素.
测试NPM SA,而不是体积,决定 ME 诱导的 LV 功能障碍的严重程度的假设.

主要方法:

在48只猪的左前下垂冠状动脉中注射了不同尺寸的微球 (10 , 30 , 100微米).
利用电子束计算断层扫描 (CT) 来评估心肌 perfusion 和 LV 壁加厚 (DeltaWT) 和中风体积 (DeltaSV) 的变化.
量化NPM体积和SA使用微CT对心肌活检和测量肌酸酸酶 (CK) 冲洗.

主要成果:

LV功能障碍 (DeltaWT,DeltaSV) 和CK洗与总NPMSA (r=0.95,P<0.001;r=0.68,P<0.01;r=0.88,P=0.01) 相比,与总NPM体积 (r=0.59,P>0.05;r=0.46,P>0.05;r=0.69,P=0.04) 相比,与总NPMSA (r=0.95,P<0.001;r=0.68,P<0.01;r=0.88,P=0.01) 相比,与总NPM体积 (r=0.59,P>0.05;r=0.46,P>0.05;r=0.69,P=0.04) 相比,相关性明显更强.
与NPM体积相比,在NPM SA和功能参数之间观察到更高的相关系数.

结论:

冠状动脉微栓塞后的左心室功能障碍与非 perfused 心肌区域的总表面积更密切相关.
微血管损伤的表面积,而不是非 perfused 组织的总体体积,是 ME 诱导的 LV 功能障碍的关键因素.

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