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경피적 관동맥 성형술시 반복적인 혈류차단 - 재관류에 따른 관동맥내 심전도의 변화
김주한(Ju Han Kim),김준우(Joon Woo Kim),김성희(Sung Hee Kim),김남호(Nam Ho Kim),박우석(Woo Suck Park),박주형(Joo Hyung Park),길광채(Gwang Chae Gill),정명호(Myung Ho Jeong),조정관(Jeong Gwan Cho),박종춘(Jong Chun Park),강정채(Jung Cha 대한내과학회 1997 대한내과학회지 Vol.53 No.3
N/A Objective : Brief epidodes of ischemia have been shown to make the heart more resistant to subsequent ischemia in animal studies(known as ischemic preconditioning, IP). This phenomenon was tested in patients undergoing percutaneous transluminal coronary angioplasty(PTCA). Methods: Thirteen patients who had significant epicardial coronary stenosis without myocardial infarction, ventricular hypertrophy or conduction defect, received two to four 2-min balloon inflations separated by 5 min of reperfusion. Surface electrocardiogram(S-ECG) and intracoronary electrocardiogram (IC-ECG) from an angioplasty guide wire were recorded before and after balloon inflation. Results: The changes of ST segment were observed in 13 out of 15 lesions on IC-ECG and 7 on S-ECG. The maximal ST changes on IC-ECG and S-ECG were 20.2±13.7mm and 1.21.5mm respectively(p<0.01). The time to beginning of ST segment change after balloon inflation were 10.1±12.6 seconds and 63.3±14.2 seconds on IC-ECG and S-ECG, respectively(p<0.01). The maximal changes of ST segment on IC-ECG during the second inflation were significantly lower than that during the first(20.2±13.7 vs 16.312.3mm, p<0.05). However, changes of R wave, T wave and QT interval were not significantly different between two inflations. The recovery time to baseling ECG after initiation of reperfusion were 50.2±41.7 seconds and 38.5±29.6 seconds for the first inflation and the second, respectively(P<0.05). Conclusion: These results suggest that IC-ECG is more sensitive and reliable than S-ECG in detection of myocardial ischemia and that IP may occur during PTCA since ST segment shift is decreased and is normalized earlier at the second balloon inflation compared with the first.