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Titolo:
MICROVASCULAR INTEGRITY INDICATES MYOCELLULAR VIABILITY IN PATIENTS WITH RECENT MYOCARDIAL-INFARCTION - NEW INSIGHTS USING MYOCARDIAL CONTRAST ECHOCARDIOGRAPHY
Autore:
RAGOSTA M; CAMARANO G; KAUL S; POWERS ER; SAREMBOCK IJ; GIMPLE LW;
Indirizzi:
UNIV VIRGINIA,MED CTR,SCH MED,DIV CARDIOVASC,BOX 158 CHARLOTTESVILLE VA 22908 UNIV VIRGINIA,MED CTR,SCH MED,DIV CARDIOVASC CHARLOTTESVILLE VA 22908
Titolo Testata:
Circulation
fascicolo: 6, volume: 89, anno: 1994,
pagine: 2562 - 2569
SICI:
0009-7322(1994)89:6<2562:MIIMVI>2.0.ZU;2-S
Fonte:
ISI
Lingua:
ENG
Soggetto:
LEFT-VENTRICULAR FUNCTION; TWO-DIMENSIONAL ECHOCARDIOGRAPHY; CORONARY-ARTERY REPERFUSION; COLLATERAL BLOOD-FLOW; BYPASS SURGERY; NO-REFLOW; PERFUSION; OCCLUSION; AREA; RESERVE;
Keywords:
INFARCTION; ECHOCARDIOGRAPHY; ANGIOGRAPHY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
51
Recensione:
Indirizzi per estratti:
Citazione:
M. Ragosta et al., "MICROVASCULAR INTEGRITY INDICATES MYOCELLULAR VIABILITY IN PATIENTS WITH RECENT MYOCARDIAL-INFARCTION - NEW INSIGHTS USING MYOCARDIAL CONTRAST ECHOCARDIOGRAPHY", Circulation, 89(6), 1994, pp. 2562-2569

Abstract

Background Patency of the infarct-related artery (IRA) after acute myocardial infarction (AMI) may not reflect the magnitude of tissue perfusion. In animal models of AMI, myocardial cellular necrosis has been associated with extensive capillary damage. Because myocardial contrast echocardiography (MCE) can define the spatial distribution of microvascular perfusion, we hypothesized that it could be used in patients after recent AMI to distinguish myocardial regions that have an intact microvasculature and thus are viable from those without an intact microvasculature and thus are not viable. Methods and Results One hundred five patients with a recent AMI (range, 1 day to 4 weeks; median, 8 days) who were undergoing cardiac catheterization were included in the study. Two-dimensional echocardiography was performed at baseline and repeated 1 month later to assess regional function within the infarct zone (scores of 1 to 5 indicating normal to dyskinetic segments, respectively). MCE was performed in the cardiac catheterization laboratory to assess microvascular perfusion within the infarct bed. A contrast score index was derived by assigning scores to individual segments within the infarct zone (0, 0.5, and 1 denoting no, intermediate, and homogeneous contrast effect, respectively) and deriving the average score within the infarct bed. Revascularization was performed as clinically indicated. Although the baseline wall motion score and the contrast score index were similar in the 90 patients with a patent IRA and the 15 patients with an occluded IRA (median+/-1 interquartile range, 3+/-1 versus 3.5+/-1; P=.41), wall motion score 1 month later was significantly better in those with open IRAs compared with those with closed IRAs(2+/-2 versus 3+/-2, P=.05). In the 90 patients with an open IRA, a strong correlation was noted between wall motion score 1 month later and the contrast score index (p=-.64, P<.001). On multivariate analysis,the best correlate of the 1-month wall motion score was the contrast score index. Conclusions In patients studied in the cardiac catheterization laboratory between 1 day and 4 weeks after AMI, an intact microvasculature as identified by MCE indicates myocardial regions that improve function 1 month later. This study demonstrates that microvascularpatency is closely associated with myocardial cellular viability after AMI in humans.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 26/09/20 alle ore 14:05:59