급성 심근경색환자에서 측부 순환의 존재 유무에 따른 관동맥 쐐기 압력과 심근 생존력과의 관계
The Relationship between Coronary Wedge Pressure and Myocardial Viability in AMI according to Presence, or not Presence of Angiographic Collateral Circulation
- 주제(키워드) Myocardial infarction , coronary wedge pressure , myocardial viability
- 발행기관 아주대학교
- 지도교수 탁승제
- 발행년도 2006
- 학위수여년월 2006. 8
- 학위명 박사
- 학과 및 전공 일반대학원 이학계열
- 본문언어 영어
초록/요약
Purpose: In acute myocardial infarction (AMI), it was not clearly defined whether the coronary wedge pressure of infarct-related artery is related to the degree of microvascular damage or degree of collateral circulation. We evaluated the relationship between the Pcw/Pa (coronary wedge pressure/ mean aortic pressure) and microvascular integrity in AMI patients following primary percutaneous coronary intervention (PCI) according to the presence of angiographic collateral circulation or not. Patients and Methods: The study population was consisted of 33 patients (57±12 years old) with first AMI. After primary PCI, we evaluated the TIMI grade, TIMI myocardial perfusion (TMP) grade and the coronary flow reserve (CFR), hyperemic microvascular resistance index (hMVRI), and Pcw/Pa by intracoronary Doppler and pressure wire. The study patients were divided into 2 groups: group 1 (n = 23): Rentrop collateral grade 0, group 2 (n = 10): Rentrop collateral grade 1, 2 and 3. F-18 fluorodeoxyglucose-positron emission tomography (FDG-PET) was performed in all patients at 7 days after PCI. Results: After PCI, the Pcw/Pa was significantly correlated with the TMP grade, hMVRI, DDT (diastolic deceleration time) and FDG uptake rate in group 1 (r = -0.773, p < 0.001; r = 0.475, p = 0.047; r = -0.602, p = 0.008; r = -0.561, p = 0.010, respectively). However, the Pcw/Pa was not correlated with the TMP grade, hMVRI, CFR, DDT and FDG uptake rate in group 2. Best cutoff value of the Pcw/Pa for 50% of FDG uptake was 0.33 (AUC=0.667, sensitivity 42.1%, specificity 92.9%). Conclusion: The post-PCI Pcw/Pa in AMI may be a useful indicator of the severity of microvascular damage of infarct-related myocardium in patients without developed collateral circulation, but it may not represent the severity of microvascular damage in patients with already developed collateral circulation.
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ABSTRACT………………………………………………i
TABLE OF CONTENTS ………………………………iii
LIST OF FIGURES………………………………………v
LIST OF TABLES………………………………………vi
ABBREVIATION…………………………………………vii
I. INTRODUCTION………………………………………1
II. PATIENTS AND METHODS…………………………2
A. PATIENT PORPULATION ……………………2
B. PROCEDURE ……………………………………2
C. ANGIOGRAPHIC NALYSIS……………………3
D. INTRACORONARY DOPPLER FLOW
MEASUREMENT …………………………3
E. INTRACORONARY PRESSURE
MEASUREMENT ……………………………4
F. POSITRON EMISSION TOMOGRAPHY……4
G. STATISTICAL ANALYSIS……………………5
III. RESULTS……………………………………………6
A. CLINICAL CHARACTERISTICS ………………6
B. ANGIOGRAPHIC RESULTS ……………………8
C. RESULT OF HEMODYNAMICS, CORONARY FLOW
VELOCITY,AND INTRACORONARY
PRESSURE………………………………………10
D. POSITRON EMISSION TOMOGRAPHY
FINDING………………………………………12
E. RELATIONSHIP OF PCW/PA AND OTHER
MICROVASCULAR INTEGRITY
VARIABLES.…………………………………13
IV. DISCUSSION ………………………………………20
V. STUDY LITATION…………………………………24
VI. CONCLUSION………………………………………25
REFERENCE……………………………………………26
국문요약…………………………………………………31
