Follow-up Assessment Of No/slow Reflow Patients With Acute Myocardial Infarction After PCI Therapy By Pulse Wave Doppler Tissue Imaging

Objection:Follow-up the patients who received direct PCI therapy after AMI with Pulse Wave Doppler Tissue Imaging technology and evaluate the effect of the different TIMI(thrombolysis in acute myocardial infarction) grade on the cardiac structure and function. Method:109 patients who received direct PCI therapy after first AMI were devided into two groups by TIMI grade system according to the immediate coronary angiography after primary PCI.Reflow Group(R group) is TIMI grade =3 grade, including 76 patients. No/slow -reflow group(N group) is TIMI grade≤2 grade, including 33 subjects.According to the QRS score system ,each group was devided into two subgroup: small necrosis subgroup is ECG score ≤3 (S1_r subgroup , S1_n subgroup )and large necrosis subgroup is the group of ECGscore >3(S2_r subgroup,S2_N subgroup). LAD , LVDD, LVEF , EDT were measured with two dimensional echocardiography;systolic parameters : Ds , V_S, VTIs , ACCs and diastolic parameters : De, Ve , VTIe, E/e were measured with Pulse Wave Doppler Tissue Imaging in a week after acute myocardial infarction .All patients received 5 weeks' , 13 weeks' follow-up after infarction. Result:1, LAD in reflow group decreased significantly at 5th week and 13th week whereas it increased in the no/slow reflow group . LVEF, mitral valve annulus' Vs, VTIs improved at 13th week in reflow group, while these parameters have no significant increase in no/slow reflow group in follow-up duration. Reflow group's diastolic parameter E/A is lower at 5th week and 13th week than it at 1 week. Infarction segment's Vs, VTIs in reflow group are higher than at 13thweek than 1 week. These demonstrate that well reperfusion after PCI therapy results in significantly better cardiac structure and left ventricular functional outcome during follow-up period,while no/slow reflow group has no improvement.2x structural index LAD^ LVDD and systolic parameters :LVEF, mitral valve annulus' Ds> Vss VTIs and diastolic parameters Ve^ VTIe in no/slow reflow group is lower than reflow group at 1 week> 5th week and 13th week . Infarction segment's Ds> Vsn VTIsn Dq^ Ve^ VTIe of reflow group are higher than no/slow reflow group during follow-up time. This indicate that well reperfusion after PCI therapy results in significantly better cardiac structure and left ventricular functional outcome than does in no/slow reflow ones in every follow-up time. 3 > In small infarct size groups : LAD in reperfusion subgroup of small infarctsize group decreased significantly at 13th week than it at 1 week, whereas it increased in no/slow reflow group. Infarction segment's Vs^ VT^ ACCs are elevated in reperfusion group at 13th week than it at lweek .LAD LVEF in no/slow reflow group is worse than reperfusion group at 1 month and 13 th week. Vs VTIs of infarction segment in reperfusion group are superior than no/slow reflow group. This indicate that total cardiac function is influenced fewer in smaller infarction size,but regional systolic function indexs are abnormal .Such abnormality cannot alleviate at 13th week in no/slow reflow subgroup. 4> In big infarct size group: mitral valve annulus's Vsn VTIs increased at 13th week in no/slow reflow subgroup than at 5th and 13th week . Infarction segment's Vsn VTIs elevated obviously in reflow subgroup but there is no improvement in no/slow reflow subgroup. LAD^VDD are higher and LVEF -. mitral valve annulus Vs^ VTIs are lower in no/slow reflow group. This indicate that both structure and function of left ventricle is worse in no/slow reflow group than in reflow group.5> Although LAD^ LVDD in no/slow reflow group's small infarct size subgroup are lower than big infarct size subgroup ,there is no statistical significance between the two subgroup .LVEF is larger in the small infarct size subgroup in the follow-up duration. This implied that the effect of the infarct size is more remarkable on the systolic function than on the structure. 6% Most parameters of structure and function have no statistical significance between TIMI=2 grade group and TIMK2 grade group .Conclusion :1 > The parameters of two dimentional echocardiography and PWDTI can accurately reflect the whole and local cardiac function .Vsn VTIs can be used to analyze the movement velocity of myocardium quantitatively. Changes of Vs> VTIs in regional infarct segment may be one of the parameter which can indicate the perfusion status of myocardium.2n That both structure and function of left ventricle in acute and recovery phase is better in well reperfused patients than in no/slow reflow patients indicate the different effect of the different reperfused status on cardiac structure and function .The change in left atrium are likely more remarkable than left ventrum after no/slow reperfusion.The reperfused status will affect the recovery of cardiac structure and function in convalescence.3n No/slow reflow phenomenon exert an influence mainly on the cardiac systolic function, rather than on the structure .4n Myocardial infarction patients with TIMI=2 grade after percutaneous transluminal coronary angioplasty are similar to TIMI<2 grade ones in cardiac function. So that we should pay more attention to slow reflow patients as if they are no-reflow ones.