Nieminen M, Heikkilä J
Br Heart J. 1976 Mar;38(3):271-81. doi: 10.1136/hrt.38.3.271.
In acute myocardial infarction the overall left ventricular pump function and the regional performance of the infarcted and non-infarcted myocardial segments were studied serially by echocardiographic techniques in 24 patients during the first week of their illness. Left ventricular cavity sizes were acutely increased in 62 per cent of the patients (P less than 0-005). The end-systolic diameter in anterior infarcts increased to the greatest extent, +44 per cent, the end-diastolic diameter by +27 per cent, giving a volume of 246+/-25 ml. In the anterior myocardial infarcts all the function parameters deteriorated more than in the posteroinferior ones. Ejection fraction was subnormal (P less than 0-005) in every patient, and mean circumferential fibre shortening (Vcf) was slowed by about 30 per cent (P less than 0-005). Regionally, contraction of the infarcted area of the ventricle was asynergic in every instance, and its function was almost totally lost (P less than 0-001). Systolic paradoxical motion was a constant and stable finding in the anterior infarctions but not so in the posterior ones. While this asynergic systolic contraction may distort echocardiographic measurement of the end-systolic left vlic phase. The serial deviations from normal in the amplitude or velocity of the uninvolved segments were small, but in the case of clearly enlarged end-diastolic volumes these figures in fact indicate supernormal, compensating function. Both overall and regional performance were worst within the first 3 days of infarction, improving thereafter. The patient with a fatal course showed, instead, progressive deterioration. This noninvasive left ventriculogram by ultrasound gives valuable insight into overall pump function and ventricular volumes, little studied so far in acute infarction, and it may serially quantify the segmental function of both the infarcted and uninvolved regions.
在急性心肌梗死患者中，采用超声心动图技术对24例患者发病第一周内的左心室整体泵功能以及梗死和未梗死心肌节段的局部功能进行了连续研究。62%的患者左心室腔大小急性增大（P<0.005）。前壁梗死患者的收缩末期直径增加幅度最大，达+44%，舒张末期直径增加+27%，容积为246±25ml。在前壁心肌梗死中，所有功能参数的恶化程度均大于下后壁梗死。每位患者的射血分数均低于正常（P<0.005），平均圆周纤维缩短率（Vcf）减慢约30%（P<0.005）。局部来看，心室梗死区域在每种情况下均表现为运动不协调，其功能几乎完全丧失（P<0.001）。收缩期矛盾运动在前壁梗死中是一个持续且稳定的表现，但在下后壁梗死中并非如此。虽然这种运动不协调的收缩期可能会使收缩末期左心室相位的超声心动图测量失真。未受累节段的振幅或速度与正常的连续偏差较小，但在舒张末期容积明显增大的情况下，这些数值实际上表明存在超常的代偿功能。整体和局部功能在梗死的前3天内最差，此后有所改善。而病情致命的患者则表现为进行性恶化。这种超声心动图无创左心室造影能为整体泵功能和心室容积提供有价值的见解，这在急性梗死中迄今研究较少，并且它可以连续量化梗死和未受累区域的节段功能。
