Objective: To evaluate the protective effects of Tongxinluo on myocardium and microvasculature after reperfusion in patients with acute myocardial infarction.
Methods: The research was performed on the patients with AMI whose initial ECG showed ST segment elevation and the patients received PCI or thrombolysis immediately after onset. These patients were classified randomly into two groups: control group in which the patients were given routine drug treatment (52 cases) and treatment group in which the patients were given routine drug plus Tongxinluo capsule (60 cases). We observed the abnormal movement of the ventricle wall in 2DE, and the change in LVEDV or LVEF on the 1st day, 7th day, 13th day, 3rd month, and 6th month after onset, which were compared with the result of DISA and SPECT for myocardial image. At the same time we also examined the blood NO and MDA levels on the 1st day, the 7th day and 13th day.
Results: (1) The recover rate for the abnormal movement of the ventricle segments in the treatment group were 11.86%, 18.12% and 18.79% respectively, which were higher than that of the control group (4.13%, 8.27% and 11.11% respectively) on the 1st week, the 2nd week, and the 1st month. At the 6th month the total recover rate for the abnormal movement of the ventricle segments of Tongxinluo group was 70.03%, which was significantly higher than that of the control group (51.68%). The WMSI was also decreased more than that of the control group. (2) The LVEDV in Tongxinluo group increased by 9.42% one week after onset, which was close to that of the control group (9.59%). There was no significant change (9.40% and 9.42% respectively) after two weeks and one month in Tongxinluo group, whereas it was increased continuously in the control group (11.84% and 12.33%). LVEDV in Tongxinluo group was decrease obviously after three and six months (3.62% and 5.07% respectively), which was close to the original level, whereas the result of the control group remained on a higher level (13.70% and 11.72% respectively). (3) LVEF of the Tongxinluo group was 53.32% before treatment, which was comparable with that of the control group (P = 0.45). There was no significant difference between the two groups after treatment for 1 week, 2 week and 1 month (P = 0.11, P = 0.13, P = 0.18, respectively). LVEF for the two groups was 58.27% and 53.40% respectively after three months and there was a statistical significance (P < 0.01). LVEF for the two groups was 58.33% and 53.82% respectively after 6 months and the difference remained statistically significant (P < 0.05). (4) The 2DE WMSI for the Tongxinluo group was 1.7552 after 12 hours to 24 hours of the CVR and there was no significant difference compared with that of the control group (WMSI = 1.5380, P = 0.6945). After 6 months, the WMSI decreased to 1.3767 in the Tongxinluo group, which was statistically different from that of the control group (WMSI = 1.5380, P < 0.01). The myocardium acquire isotope score index of the Tongxinluo group was 0.6075 at 6 months, which was significantly different from that of the control group (0.8781). (5) Ultrasonic humerus artery examination in static status showed that there was no significant difference on the diameter of blood vessel and the speed of blood stream between Tongxinluo group and control group with. The diameter of the blood vessel after artery pressure in Tongxinluo group was expanded, which was significantly different from that in the static status (P < 0.001) and that in control group (P < 0.001). The diameter of blood vessel after administration of nitroglycerin in both groups was expanded, which was significantly different from that in the static status (P < 0.001 and P < 0.05). However, Tongxinluo group was expand more obviously than that of the control group (P < 0.05). (6) The MDA level of the Tongxinluo group was decreased (all P < 0.05) and the NO level was increased (all P < 0.05) gradually from the 1st week to the 4th week; however, the MDA level of the control group was not decreased until the 4th week (P < 0.05), and the NO level of the control group was increased evidently at the 2nd week (P < 0.05).
Conclusions: (1) After reperfusion in AMI patients, administration of routine drug combined with Tongxinluo is more effective than routine drug alone in the reduction of infarction size. (2) In Tongxinluo group, the recover time and the total recover rate of the abnormal movement of the ventricle segments were higher than the control group, and the WMSI were significantly decreased than the control group. (3) The improvement degree and the recover time on LVEDV in Tongxinluo group was superior to control group. (4) The improvement of LVEF in time and in degree was superior to control group. (5) The blood concentration of the MDA was decreased significantly in Tongxinluo group, while the NO level was increased significantly, and the time was superior to control group significantly.