| Objective:To observe the effect of bolus injection of rh BNP on myocardial perfusion in patients with acute anterior myocardial infarction,and three plane speckle tracking was used to accurately evaluate the changes of cardiac function.To explore the clinical effect of early application of rh BNP on the prevention of heart failure after acute myocardial infarction,the improvement of prognosis and the reduction of residual mortality of acute myocardial infarction.Methods:From October 2018 to December 2019,149 patients with acute anterior myocardial infarction were selected(114 males and 35 females).The age range is 36-75 years old,and the average age was 63.6 ± 8.8 years.Randomly divided into rh BNP group(73 cases)and control group(76 cases).Patients in both groups received emergency coronary angiography and interventional therapy(PCI)within the effective time window.In the rh BNP group,shot type intravenous injection of rh BNP(1.5 μ g /kg)was given before PCI,and the remaining rh BNP was maintained by intravenous injection of 0.0075-0.01μg/kg/min(intravenous nitrates were used at different times).In the control group,according to the patients’ condition and the guidelines for diagnosis and treatment of acute ST segment elevation myocardial infarction,the responsible doctor made the treatment plan of nitrates.To compare the TIMI blood flow classification of infarct related vessels and the absence of corrected TIMI frames between the two groups after PCI.To compare the c Tn T,CK-MB and NT pro BNP changes in the two groups before,one day after PCI and one week after PCI.The systolic peak strain of left ventricular long axis was measured by three plane speckle tracking technique 3 days and 1 week after operation.It includes the peak strain of long axis of left ventricular apical contraction(GLPS-LAX),peak strain of four chamber apical contraction(GLPS-A4C),peak strain of two chamber apical contraction(GLPS-A2C)and global average strain rate of left ventricle(GLPS-avg).The incidence of major adverse cardiovascular events(MACE)within 3 months was recorded.Results:1.There was no significant difference in the baseline data of the two groups:age,gender,BMI,basic heart rate,blood pressure,hypertension,diabetes,hyperlipidemia,smoking,Killip classification,time from onset of AMI to time of opening of blood vessels and perioperative medication(p>0.05).2.There was no significant difference between the two groups in the proportion of patients who stopped taking rh BNP or nitrates during the perioperative period(p>0.05).3.The CK-MB of rh BNP group was significantly lower than that of the control group on the first day after operation(140.4±72.8 ng/ml vs.159.6 ±88.3 ng/ml,p=0.036),and c Tn T at 1 day and 1 week after operation was significantly lower than that of the control group(4170.8±1304.3 pg/ml vs.5192.4±1646.8 pg/ml,p=0.014,1047.7±574.4 pg/ml vs.1748.1±798.2 pg/ml,p=0.011).The NT-pro BNP of 1 day and 1 week after operation was also significantly lower than that of the control group(1484.1±693.9 pg/ml vs.1990.4±786.9 pg/ml,p=0.021,1376.4±886.2 pg/ml vs.3044.6±754.5 pg/ml,p=0.018).4.Reexamination immediately after PCI in two groups.The proportion of TIMI 3 blood flow of infarct related artery in rh BNP group was higher than that in control group,but the difference was not statistically significant.(95.9% vs.89.5%,p=0.134).The number of corrected TIMI frames in rh BNP group was significantly lower than that in the control group(20.9±6.3 vs.24.9±9.1,p=0.002).5.Three days after operation,the absolute values of the strain parameters measured by 3P-STI in rh BNP group was significantly higher than that in the control group: GLPS-LAX(-14.0±3.6% vs.-12.1±4.4%,p=0.04),GLPS-A4C(-14.1±4.3%vs.-12.2±4.5%,p=0.043),GLPS-A2C(-14.5±3.5% vs.-12.0±4.7%,p=0.015),GLPS-avg(-14.3±4.2% vs.-12.2±4.8%,p=0.019).Three days after operation,the absolute values of the strain parameters measured by 3P-STI in rh BNP group was significantly higher than that in the control group: GLPS-LAX(-15.6±4.2% vs.-13.6±4.4%,p=0.004),GLPS-A4C(-15.5±3.3% vs.-13.2±4.4%,p=0.001),GLPS-A2C(-15.8±4.1% vs.-13.1±4.5%,p=0.002),GLPS-avg(-15.6±3.5% vs.-13.6±4.2%,p=0.002).6.Within 3 months after PCI,the incidence of rehospitalization of heart failure in rh BNPgroup was significantly lower than that in the control group(4.1% vs.13.2%,p=0.045).The cardiac death of rh BNP group was lower than that of the control group,but there was no statistical difference(2.7% vs.5.3%,p=0.233).The incidence of combined end point of rehospitalization of heart failure + cardiac death in rh BNP group was significantly lower than that in the control group(6.8% vs.18.4%,p=0.034).Conclusion: 1.For patients with acute anterior myocardial infarction,bolus injection of rh BNP before PCI can improve coronary blood flow and myocardial perfusion.2.For patients with acute anterior myocardial infarction,bolus injection of rh BNP before PCI can significantly improve heart function,reduce the rate of rehospitalization of heart failure and the rate of rehospitalization of heart failure + cardiac death three months after PCI,and has important value for improving clinical prognosis. |
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