Shen W F, Tribouilloy C, Mirode A, Dufossé H, Lesbre J P
Department of Cardiology, South Hospital, University of Picardie, Amiens, France.
Eur Heart J. 1992 Jan;13(1):39-44. doi: 10.1093/oxfordjournals.eurheartj.a060045.
To determine the clinical and angiographic factors responsible for left ventricular aneurysm formation and the prognosis of patients with aneurysm, 79 patients with a first acute transmural anterior myocardial infarction and angiographically documented isolated left anterior descending artery disease were retrospectively evaluated. Presence of large infarct size and left ventricular volumes, reduced left ventricular function, and evidence of clinical functional impairment were more common in patients with aneurysm (n = 31) than in those without (n = 48). Patients with aneurysm often had total occlusion of the proximal left anterior descending artery without collateral vessels on angiography. During a mean follow-up of 53 months, 10 patients with and three without aneurysm died (P less than 0.01). Compared to survivors with or without aneurysm, the nonsurvivors were older, had significantly larger infarct size and left ventricular volumes and poor systolic function. The incidence of total occlusion of the left anterior descending artery without collaterals was higher in nonsurvivors. In patients with aneurysm, stepwise multivariate analysis revealed that left ventricular ejection fraction and the status of left anterior descending artery obstruction and collaterals were independent predictors of mortality. The study indicates that in patients with a first acute transmural anterior myocardial infarction and isolated anterior descending artery disease, left ventricular aneurysm often results from a large infarct caused by total occlusion of the proximal left anterior descending artery without collateral supply to the infarct region. The reduced survival rate for patients with aneurysm is primarily related to severe global left ventricular dysfunction which may be determined by assessing the residual flow to the infarct region.
为了确定导致左心室动脉瘤形成的临床和血管造影因素以及动脉瘤患者的预后，我们对79例首次发生急性透壁性前壁心肌梗死且血管造影证实为孤立性左前降支动脉疾病的患者进行了回顾性评估。与无动脉瘤的患者（n = 48）相比，有动脉瘤的患者（n = 31）更常出现大面积梗死灶和左心室容积增大、左心室功能降低以及临床功能障碍的证据。有动脉瘤的患者在血管造影时左前降支近端常完全闭塞且无侧支血管。在平均53个月的随访期间，有10例有动脉瘤的患者和3例无动脉瘤的患者死亡（P<0.01）。与有或无动脉瘤的幸存者相比，非幸存者年龄更大，梗死灶和左心室容积明显更大，收缩功能较差。非幸存者中左前降支无侧支完全闭塞的发生率更高。在有动脉瘤的患者中，逐步多因素分析显示左心室射血分数、左前降支动脉阻塞和侧支血管情况是死亡率的独立预测因素。该研究表明，在首次发生急性透壁性前壁心肌梗死且患有孤立性前降支动脉疾病的患者中，左心室动脉瘤通常是由近端左前降支动脉完全闭塞导致大面积梗死，且梗死区域无侧支供血引起的。动脉瘤患者生存率降低主要与严重的全心室功能障碍有关，这可通过评估梗死区域的残余血流来确定。
