TIMI血流计帧法测定冠状动脉血液流速在急性心肌梗死再灌注治疗中的应用

Clinical application of coronary flow velocity assessing by the method of frame counting in reperfusion therapy of acute myocardial infarction

  • 摘要: 目的:评价计帧法测定冠状动脉血流速度在急性心肌梗死(AMI)再灌注治疗中的临床意义。方法:90例急性心肌梗死患者行直接经皮冠状动脉成形术(PTCA)、溶栓失败后的挽救性PTCA治疗和延迟PTCA治疗,梗死相关动脉成功再通,心肌梗死溶栓实验(TIMI)血流分级2级或3级,用计帧法法测定梗死相关动脉(IRA)帧数,结合IRA长度测定血流速度,观察帧数、血流速度和心功能、近期临床预后的关系。结果:IRA平均长度为(119.30±25.26) mm,平均CTFC为(37.36±19.70)帧,平均流速为(100.33±41.92) mm/s,左室射血分数(LVEF)和IRA帧数负相关(r=-0.64,P=0.01),LVEF和IRA血流速度正相关(r=0.74,P=0.00)。住院期间有心脏不良事件组和无不良事件组间血流速度有统计学差异(167.20±36.75vs105.78±30.85,P<0.05),CTFC>30祯和<30帧组间射血分数、住院期间心脏不良事件发生率有显著性差异(P<0.05)。Logistic多元回归分析发现血流速度是心脏不良事件的独立相关因素(OR=2.41,95% CI=1.95~2.83,P=0.00)。结论:计帧法测定IRA帧数和血流速度是一种较好的评价冠状动脉血流的方法,其结果和心功能、临床近期预后密切相关。

     

    Abstract: Objective: To assess the clinical significance of coronary flow velocity assessing by the method of frame counting in reperfusion therapy of acute myocardial infarction(AMI). Methods: In 90 patients with AMI, after being taken successfully direct or rescue percutaneous transluminal coronary angioplasty(PTCA), the frame counting method was used to count the number of cineframes of infarction related artery(IRA). The flow velocity of IRA was detected by the combination of the length of IRA and the cardiac function was measured by echocardiogram after PTCA. Results: In all the patients, the mean number of cineframes of IRA was 37.36 19.70, and the flow velocity of IRA is 134.58 47.57mm/s. The flow velocity of IRA was positive relation with the left ventricular ejection fractions (r=0 74, P =0.00) and CTFC was negative relation with the left ventricular ejection fractions (r=-0 64, P=0.01).The patients with CTFC <30 had higher LVEF and lower incidence of cardiac events (P <0.05, respectively).The flow velocity of IRA were significantly different between the group with cardiac events and the group without cardiac events(167.20±36.75 vs 105.78±30.85, P<0.05). Logistic regression showed the flow velocity of IRA was well related with the incidence of cardiac events during admission(OR =2.41,95%CI=1.95~2.83, P=0.00). Conclusions: The frame counting of IRA is a simple, objective and quantitative method that allows standardization of the IRA flow, and associated with cardiac function and the incidence of cardiac events during admission.

     

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