Morimoto Shin-Ichiro, Kato Shigeru, Hiramitsu Shinya, Uemura Akihisa, Ohtsuki Masatsugu, Kato Yasuchika, Sugiura Atsushi, Miyagishima Kenji, Iwase Masatsugu, Ito Teruo, Hishida Hitoshi
Division of Cardiology, Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.
Circ J. 2003 Jun;67(6):490-4. doi: 10.1253/circj.67.490.
It has been reported that some patients with acute myocarditis have transient ventricular thickening associated with narrowing of the left ventricular cavity caused by interstitial edema. The present study investigated this phenomenon in 20 patients with acute myocarditis. Based on the sum of the interventricular septal wall thickness and left ventricular posterior wall thickness (IVST + PWT), measured by M-mode echocardiography, patients were divided into group A (IVST + PWT >/=25 mm, n=12) and group B (IVST + PWT <25 mm, n=8). The IVST + PWT was 31.8 +/-3.5 mm in group A and 21.9+/-2.7 mm in group B (p<0.0001). The left ventricular end-diastolic dimension (LVDd) was 42.3+/-6.0 mm in group A and 49.4+/-6.7 mm in group B (p<0.05). The stroke volume (SV) was 41.1+/-20.5 ml and 73.0+/-32.3 ml in groups A and B, respectively (p<0.05). The left ventricular ejection fraction (LVEF) was similar in group A (47.9+/-13.0%) and group B (56.9+/-9.0%). The SV correlated inversely with IVST + PWT (r=-0.62, p<0.01), and directly with both the LVDd (r=0.95, p<0.0001) and LVEF (r=0.64, p<0.01). The LVDd correlated inversely with IVST + PWT (r=-0.62, p<0.01). In conclusion, the reduction in SV that occurs during the acute phase of myocarditis is not only the result of systolic dysfunction, but also of the concentric left ventricular wall thickening associated with myocardial interstitial edema, which results in narrowing of the left ventricular cavity at end diastole.
据报道，一些急性心肌炎患者存在短暂性心室增厚，伴有因间质水肿导致的左心室腔狭窄。本研究对20例急性心肌炎患者的这一现象进行了调查。根据M型超声心动图测量的室间隔壁厚度与左心室后壁厚度之和（IVST + PWT），将患者分为A组（IVST + PWT≥25 mm，n = 12）和B组（IVST + PWT < 25 mm，n = 8）。A组的IVST + PWT为31.8±3.5 mm，B组为21.9±2.7 mm（p < 0.0001）。A组的左心室舒张末期内径（LVDd）为42.3±6.0 mm，B组为49.4±6.7 mm（p < 0.05）。A组和B组的每搏输出量（SV）分别为41.1±20.5 ml和73.0±32.3 ml（p < 0.05）。A组（47.9±13.0%）和B组（56.9±9.0%）的左心室射血分数（LVEF）相似。SV与IVST + PWT呈负相关（r = -0.62，p < 0.01），与LVDd（r = 0.95，p < 0.0001）和LVEF（r = 0.64，p < 0.01）均呈正相关。LVDd与IVST + PWT呈负相关（r = -0.62，p < 0.01）。总之，心肌炎急性期出现的SV降低不仅是收缩功能障碍的结果，也是与心肌间质水肿相关的左心室壁向心性增厚的结果，这导致舒张末期左心室腔狭窄。
