简介：

简介：

简介：ObjectivesThelong-termbenefitoflatereperfusionofinfarct-relatedartery(IRA)afteracutemyocardialinfarction(AMI)iscontroversial,andthebenefitmechanismsremainuncertain.Lowdosedobutaminestressechocardiography(LDSE)canidentifyviablemyocardiumandpredictimprovementofwallmotionafterrevascularization.MethodsSixty-ninepatientswithfirstAMIwhodidnotreceivedearlyreperfusiontherapywerestudiedbyLDSEat5to10daysafterAMI.Wallmotionabnormalityandleftventricularsizeweremeasuredatthesametime.SuccessfulPCIweredoneinallpatientsat10to21daysafterAMIonset.Patientsweredividedintwogroupsbasedonthepresenceorabsenceofviablemyocardium.Echocardiographywasrepeatedsixmonthslater.ResultsTherewere157motionabnormalitysegments.89segments(57%)wereviableduringLDSE.26patients(38%)withviabilityand43(62%)without.Inviablegroup,leftventricularejectionfraction(LVEF)wasincreased(P<0.05),andleftventricularendsystolicvolumeindex(LVESVI)andwallmotionscore(WMS)weredecreased(P<0.05andP<0.01)significantlyat6monthscomparedwithbaseline.Butinpatientswithoutviability,LVEFwasdecreased(P<0.01),andLVESVIandleftventricularenddiastolicvolumeindex(LVEDVI)wereincreased(P<0.05)significantlyafter6months,andtheWMSdidnotchanged(P>0.05).LVEFincreased(P<0.05)andWMSdecreased(P<0.05)onLDSEduringacutephaseinpatientswithviability,buttheywerenotchangedinthenonviablegroup.ConclusionsLaterevascularizationofIRAinpatientswithpresenceofviablemyocardiumafterAMIisassociatedwithlong-termpreservationleftventricularfunctionandlessventricularremodeling.ImprovementofleftventricularsystolicfunctiononLDSEindicateslatephaserecoveryofleftventricularfunctionafterlaterevascularization.

简介：ObjectivesTocomparethedifferenteffectsoflatesuccessfulreperfusionwithPCIonleftventricularfunctionanditsrelationshipwithviablemyocardiumafteracuteanteriorwallmyocardialinfarctioninpatientswithorwithoutdiabetes.MethodsAtotalof125consecutivesubjectswithacuteanteriorwallmyocardialinfarctionwereselected,anddividedintodiabetesmellitus(DM)group(n=43)andNon-DMgroup(n=82)accordingtoWHOdiabetesdiagnosiscriteria.AllpatientsreceivedsuccessfulPCIat12±8daysfromonset.Ischemicviablemyocardiumwasdetectedwithlow-dosedobutamineechocardiography,andleftventricularfunctionandwallmotionabnormalitywerealsoassessedwithechocardiographybeforePCI.ThedataofclinicalmanifestationsandangiogramsbeforeandafterPCIwereanalyzed.Levelsofcreatininekinase-MB(CK-MB),andtroponinT(TnT)beforePCI,6hoursand24hoursafterPCIwereassessed.Allpatientsreceivedclinicandechocardiographyfollow-upfor6months.ResultsHigherrateofTIMI2flow,andlowerrateofTIMI3flowinDMgroupweredemonstratedimmediatelyafterPCI,andtherateofserumCK-MBand/orTnTlevelswerehigherinDMgroup,comparedwithNon-DMgroup(P<0.05).63%ofDMpatientsand56%ofnon-DMpatientshadviablemyocardiumbeforePCI(P>0.05).Therewerenosignificantdifferencesofleftventricularejectionfraction(LVEF),leftventricularenddiastolicvolumeindex(LVEDVI),leftventricularendsystolicvolumeindex(LVESVI),andwallmotionscore(WMS)betweentwogroupsatbaselinebeforePCI(P>0.05).Aftersixmonths,WMSwasdecreasedandLVEFwasincreasedinNon-DMgroup,buttheWMSandtheLVEFdidnotchanged,andtheLVEDVIwasincreasedinDMgroupcomparedwithbaseline;theLVEDVI,LVESVI,LVEF,andWMSweresignificantlydifferentbetweentwogroups(P<0.05orP<0.01).ConclusionsComparedwithnon-diabetics,delayedsuccessfulrevascularizationwithPCIindiabeticspatientwithacutemyocardialinfarctionhaslessbenefitialeffectontheimprovementoflatephasel