| The formation of ventricular aneurysm (VA) after acute myocardial infarction (AMI) is a pathophysiologic process of myocardial structure and ventricular geometry volume remodeling caused by contractive stretching effect between normal tension muscle and loss tension muscle involved in necrotic, injurious and ischemic myocardium around the myocardial infarction area. VA is a extreme manifestation of ventricular remodeling that deteriorated the hemodynamic abnormality, and is a main determinative factor for the cardiac accident and long term prognosis after AMI.To gain the effective myocardial reperfusion in the early stage of AMI, the complete and persistent repatency of infarcted related artery (IRA) is the key management to protect ventricular function and reverse VA formation. The intravenous thrombolytic therapy is a simple, convenient and economic, and can practice in clinic within a short time after AMI onset, but it merely gains 50-70% repatency rate of IRA, and arrives at TIMI-II grade flow in half of them. Simultaneously the ischemic recurrence and IRA reocclusion rate may arrive above 15-30%. Although the primary percutaneous coronary intervention (PCI) can completely and persistently reopen the IRA, the reperfusion time is delayed of 40-60 min as compared to that of thrombolytic treatment. It is unclear whether the facilitated PCI which the thrombolysis and combined with primary PCI therapy is prior to the any one of them in the much early, complete and persistent repatency of IRA with salvage of much more myocardium. To compare and evaluate reversed effect on VA formation and influence on the cardiac systolic function and synchronization with thrombolysis, primary PCI and facilitated PCI by 99mTc-MIBI myocardial perfusion imaging combined catheterized left ventriculography (LVG) and equilibrium radionuclide angiography (ERNA) will conduct a efficient evaluation from the ventricular function and morphologic alteration and provide a excellent choice to prevent from formation of VA and protect ventricular performance.Recently, some experimental researches have shown that the TIMI-III grade flow of repatenced IRA can not reflect the effective reperfusion in myocardium tissue level, if it was recognized by myocardial blush grades (MBG) criterion. MBG is a simple, direct and effective method for myocardial reperfusion after PCI in AMI patients that has be proved by recent investigations. The 0 or I grade identified by MBG classification has been accepted as the clinic diagnosis criterion of no reflow phenomenon post PCI procedure. Until now, there is no clinic report of the short and long term influence on the VA formation, reginal and globle cardiac function as well the synchronization for no reflow phenomenon of IRA identified by MBG. To probe these influences by LVG and ERNA with phase analysis technique will contribute to the recognition of no reflow phenomenon in VA formation and raise the level of the prevention and management for no reflow phenomenon post PCI in clinic.The myocardial necrotic and inflammatory markers are significantly increased, directly or indirectly due to the acute ischemia, injury and necrosis of myocardium and the increased impact on the ventricular wall tension and intraventricular pressure-volume load. The level of brain natriuretic peptide (BNP), cardiac troponin I (cTnI) and interleukin-8 (IL-8) respectively reflect the influence on ventricular wall mechanical tension alteration, the immune inflammation reaction of myocardium and vessels and the extent and depth degree of AMI during the process of VA formation and acute ventricular remodeling after AMI. Integral measurements of these three myocardial necrotic and inflammatory markers are beneficial to the prediction and evaluation of VA formation and cardiac performance after AMI. However, the change of myocardial necrosis and inflammation marker's level and their relationship with the formation and development of VA after AMI have still been unclear in present. To dynamically measure the level alteration of the th...
|
PDF Full Text Request