-
摘要: 在急性心肌梗死患者中, 通过经皮冠状动脉介入治疗进行血管重建能够有效降低死亡率。然而, 即使成功开通了心外膜血管, 仍有相当比例的急性心肌梗死患者发展为慢性心力衰竭。研究发现, 冠状动脉微血管阻塞引起的"无复流"现象及随后出现的心肌内出血是参与此过程的重要因素。了解心肌内出血在"无复流"现象和心肌损伤中的作用, 对制定新的急性心肌梗死治疗策略至关重要。本文将对心肌内出血的病理生理学、影像学、临床意义和治疗策略等最新进展进行综述。Abstract: In patients with acute myocardial infarction, mechanical revascularization by percutaneous coronary intervention can effectively reduce mortality. However, a substantial proportion of patients with acute myocardial infarction develop chronic cardiac failure, despite restoration of epicardial vessel patency. It is found that the phenomenon of "no-reflow" caused by coronary microvascular obstruction and the subsequent myocardial hemorrhage are the important factors involved in this process. Understanding of the role of intramyocardial haemorrhage in the no-reflow phenomenon and myocardial injury is crucial to the development of new therapeutic strategies to treat acute myocardial infarction. In this article, we reviewed the latest development in pathophysiology, imaging, clinical significance, and therapeutic strategies of intramyocardial hemorrhage.利益冲突 无
-
[1] Nabel EG, Braunwald E. A tale of coronary artery disease and myocardial infarction[J]. N Engl J Med, 2012, 366:54-63. doi: 10.1056/NEJMra1112570 [2] Levi F, Lucchini F, Negri E, et al. Trends in mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world[J]. Heart, 2002, 88:119-124. doi: 10.1136/heart.88.2.119 [3] Wu X, Mintz GS, Xu K, et al. The relationship between attenuated plaque identified by intravascular ultrasound and no-reflow after stenting in acute myocardial infarction:the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial[J]. JACC Cardiovasc Interv, 2011, 4:495-502. http://www.ncbi.nlm.nih.gov/pubmed/21596321 [4] Robbers LF, Eerenberg ES, Teunissen PF, et al. Magnetic resonance imaging-defined areas of microvascular obstruction after acute myocardial infarction represent microvascular destruction and haemorrhage[J]. Eur Heart J, 2013, 34:2346-2353. doi: 10.1093/eurheartj/eht100 [5] Ganame J, Messalli G, Dymarkowski S, et al. Impact of myocardial haemorrhage on left ventricular function and remodelling in patients with reperfused acute myocardial infarction[J]. Eur Heart J, 2009, 30:1440-1449. doi: 10.1093/eurheartj/ehp093 [6] Jennings RB, Sommers HM, Smyth GA, et al. Myocardial necrosis induced by temporary occlusion of a coronary artery in the dog[J]. Arch Pathol, 1960, 70:68-78. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=10.1177/000331979004100304 [7] Kloner RA, Ganote CE, Jennings RB. The no-reflow phenomenon after temporary coronary occlusion in the dog[J]. J Clin Invest, 1974, 54:1496-1508. doi: 10.1172/JCI107898 [8] Mathey DG, Schofer J, Kuck KH, et al. Transmural, haemorrhagic myocardial infarction after intracoronary strepto-kinase. Clinical, angiographic, and necropsy findings[J]. Br Heart J, 1982, 48:546-551. doi: 10.1136/hrt.48.6.546 [9] Kali A, Tang RL, Kumar A, et al. Detection of acute reperfusion myocardial hemorrhage with cardiac MR imaging:T2 versus T2*[J]. Radiology, 2013, 269:387-395. doi: 10.1148/radiol.13122397 [10] McNamara JJ, Lacro RV, Yee M, et al. Hemorrhagic infarction and coronary reperfusion[J]. J Thorac Cardiovasc Surg, 1981, 81:498-501. doi: 10.1016/S0022-5223(19)39478-4 [11] Driesen RB, Zalewski J, Vanden Driessche N, et al. Histological correlate of a cardiac magnetic resonance imaged microvascular obstruction in a porcine model of ischemia-reperfusion[J]. Cardiovasc Pathol, 2012, 21:129-131. doi: 10.1016/j.carpath.2011.07.008 [12] Braunwald E, Kloner RA. Myocardial reperfusion:a double-edged sword?[J] J Clin Invest, 1985, 76:1713-1719. doi: 10.1172/JCI112160 [13] Zaman AK, French CJ, Spees JL, et al. Vascular rhexis in mice subjected to non-sustained myocardial ischemia and its therapeutic implications[J]. Exp Biol Med (Maywood), 2011, 236:598-603. doi: 10.1258/ebm.2011.011026 [14] Fishbein MC, Y-Rit J, Lando U, et al. The relationship of vascular injury and myocardial hemorrhage to necrosis after reperfusion[J]. Circulation, 1980, 62:1274-1279. doi: 10.1161/01.CIR.62.6.1274 [15] Reffelmann T, Kloner RA. Microvascular reperfusion injury:rapid expansion of anatomic no reflow during reperfusion in the rabbit[J]. Am J Physiol Heart Circ Physiol, 2002, 283:H1099- H1107. doi: 10.1152/ajpheart.00270.2002 [16] Marra MP, Cacciavillani L, Corbetti F, et al. The contribution of intramyocardial hemorrhage to the "no-reflow phenomenon":a study performed by cardiac magnetic resonance[J]. Echocardiography, 2010, 27:1120-1129. doi: 10.1111/j.1540-8175.2010.01213.x [17] Bulluck H, Dharmakumar R, Arai AE, et al. Cardiovascular Magnetic Resonance in Acute ST-Segment-Elevation Myocardial Infarction:Recent Advances, Controversies, and Future Directions[J]. Circulation, 2018, 137:1949-1964. doi: 10.1161/CIRCULATIONAHA.117.030693 [18] 周慷, 石海峰, 苏佰燕, 等.磁共振引导聚焦超声:现状与前景[J].协和医学杂志, 2020, 11:1-5. http://kns.cnki.net/KCMS/detail/detail.aspx?dbcode=CJFD&filename=XHYX202001002 [19] O'Regan DP, Ariff B, Neuwirth C, et al. Assessment of severe reperfusion injury with T2* cardiac MRI in patients with acute myocardial infarction[J]. Heart, 2010, 96:1885-1891. doi: 10.1136/hrt.2010.200634 [20] Hamirani YS, Wong A, Kramer CM, et al. Effect of microvascular obstruction and intramyocardial hemorrhage by CMR on LV remodeling and outcomes after myocardial infarction:a systematic review and meta-analysis[J]. JACC Cardiovasc Imaging, 2014, 7:940-952. doi: 10.1016/j.jcmg.2014.06.012 [21] Bulluck H, Rosmini S, Abdel-Gadir A, et al. Diagnostic performance of T1 and T2 mapping to detect intramyocardial hemorrhage in reperfused ST- segment elevation myocardial infarction (STEMI) patients[J]. J Magn Reson Imaging, 2017, 46:877-886. doi: 10.1002/jmri.25638 [22] Kali A, Cokic I, Tang R, et al. Persistent microvascular obstruction after myocardial infarction culminates in the confluence of ferric iron oxide crystals, proinflammatory burden, and adverse remodeling[J]. Circ Cardiovasc Imaging, 2016, 9.pii:e004996. http://www.ncbi.nlm.nih.gov/pubmed/27903536 [23] Bulluck H, Rosmini S, Abdel-Gadir A, et al. Residual myocardial iron following intramyocardial hemorrhage during the convalescent phase of reperfused ST-segment-elevation myocardial infarction and adverse left ventricular remodeling[J]. Circ Cardiovasc Imaging, 2016, 9. pii:e004940. http://europepmc.org/articles/PMC5068185/ [24] Carberry J, Carrick D, Haig C, et al. Persistent iron within the infarct core after ST-segment elevation myocardial infarction:implications for left ventricular remodeling and health outcomes[J]. JACC Cardiovasc Imaging, 2018, 11:1248-1256. doi: 10.1016/j.jcmg.2017.08.027 [25] Reinstadler SJ, Stiermaier T, Reindl M, et al. Intramyocardial haemorrhage and prognosis after ST-elevation myocardial infarction[J]. Eur Heart J Cardiovasc Imaging, 2019, 20:138-146. doi: 10.1093/ehjci/jey101 [26] Beek AM, Nijveldt R, van Rossum AC. Intramyocardial hemorrhage and microvascular obstruction after primary percutaneous coronary intervention[J]. Int J Cardiovasc Imaging, 2010, 26:49-55. doi: 10.1007/s10554-009-9499-1 [27] Amabile N, Jacquier A, Shuhab A, et al. Incidence, predictors, and prognostic value of intramyocardial hemorrhage lesions in ST elevation myocardial infarction[J]. Catheter Cardiovasc Interv, 2012, 79:1101-1108. doi: 10.1002/ccd.23278 [28] Stork A, Lund GK, Muellerleile K, et al. Characterization of the peri-infarction zone using T2-weighted MRI and delayed-enhancement MRI in patients with acute myocardial infarction[J]. Eur Radiol, 2006, 16:2350-2357. doi: 10.1007/s00330-006-0232-3 [29] Tartan Z, Ozer N, Uyarel H, et al. Metabolic syndrome is a predictor for an ECG sign of no-reflow after primary PCI in patients with acute ST-elevation myocardial infarction[J]. Nutr Metab Cardiovasc Dis, 2008, 18:441-447. doi: 10.1016/j.numecd.2007.02.015 [30] Amier RP, Tijssen RYG, Teunissen PFA, et al. Predictors of Intramyocardial Hemorrhage After Reperfused ST-Segment Elevation Myocardial Infarction[J]. J Am Heart Assoc, 2017, 6.pii:e005651. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5586425/ [31] Maxwell L, Gavin JB. The role of post-ischaemic reperfusion in the development of microvascular incompetence and ultrastructural damage in the myocardium[J]. Basic Res Cardiol, 1991, 86:544-553. doi: 10.1007/BF02190704 [32] Kloner RA. Current state of clinical translation of cardioprotective agents for acute myocardial infarction[J]. Circ Res, 2013, 113:451-463. doi: 10.1161/CIRCRESAHA.112.300627 [33] Zhang J, Ding L, Zhao Y, et al. Collagen-targeting vascular endothelial growth factor improves cardiac performance after myocardial infarction[J]. Circulation, 2009, 119:1776-1784. doi: 10.1161/CIRCULATIONAHA.108.800565 [34] Huang RL, Teo Z, Chong HC, et al. ANGPTL4 modulates vascular junction integrity by integrin signaling and disruption of intercellular VE-cadherin and claudin-5 clusters[J]. Blood, 2011, 118:3990-4002. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=4bcc02c9afc451f51e06008e02cfa0bc [35] Sandhu R, Teichert-Kuliszewska K, Nag S, et al. Reci-procal regulation of angiopoietin-1 and angiopoietin-2 following myocardial infarction in the rat[J]. Cardiovasc Res, 2004, 64:115-124. doi: 10.1016/j.cardiores.2004.05.013 [36] Copin JC, Merlani P, Sugawara T, et al. Delayed matrix metalloproteinase inhibition reduces intracerebral hemorrhage after embolic stroke in rats[J]. Exp Neurol, 2008, 213:196-201. doi: 10.1016/j.expneurol.2008.05.022 [37] Betgem RP, de Waard GA, Nijveldt R, et al. Intramy-ocardial haemorrhage after acute myocardial infarction[J]. Nat Rev Cardiol, 2015, 12:156-167. doi: 10.1038/nrcardio.2014.188
点击查看大图
计量
- 文章访问数: 683
- HTML全文浏览量: 62
- PDF下载量: 102
- 被引次数: 0