Heras M, Sanz G, Betriu A, Magriñá J, Pérez-Villa F, Paz M A, de Flores T
Servicio de Cardiología y Unidad Coronaria, Hospital Clínic i Provincial de Barcelona, Universidad de Barcelona.
Rev Esp Cardiol. 1992 Apr;45(4):238-44.
We have prospectively studied the prevalence and natural history of left ventricular aneurysm in a series of 386 consecutive male patients with an acute myocardial infarction. Definition of aneurysm was angiographic and based on a single plane left ventricular angiogram. There were 52 (13.5%) left ventricular aneurysms. Mean follow-up was 57 +/- 29 months (range 40-100). During this interval, 15 of the 52 patients died (29%). Univariate analysis showed that survivors had at admission significantly less prevalence of hypercholesterolemia, previous myocardial infarction and intraventricular conduction disturbances. In addition, their Killip class was better (p less than 0.02) and the left ventricular ejection fraction was higher (p less than 0.002). The survival rates of patients with ventricular aneurysm at 1, 3 and 5 years were 88, 82 and 75%, respectively. Left ventricular end diastolic pressure, number of diseased vessels and the presence of bifascicular block were independent predictors of survival. Stratification of patients according to the risk factors allowed identification of patients with excellent prognosis (those with left ventricular end diastolic pressure less than 20 mmHg, single vessel disease and no conduction disturbances) and others with high risk of death (left ventricular end diastolic pressure greater than or equal to 20 mmHg, three vessel disease and bifascicular block). Survival at 5 years for these two groups were 81% vs 50%, respectively (p less than 0.005).
我们前瞻性地研究了386例连续的急性心肌梗死男性患者左心室室壁瘤的患病率及自然病史。室壁瘤的定义基于血管造影，并以单平面左心室血管造影为依据。共有52例（13.5%）左心室室壁瘤患者。平均随访时间为57±29个月（范围40 - 100个月）。在此期间，52例患者中有15例死亡（29%）。单因素分析显示，幸存者入院时高胆固醇血症、既往心肌梗死和室内传导障碍的患病率显著较低。此外，他们的心功能Killip分级更好（p<0.02），左心室射血分数更高（p<0.002）。室壁瘤患者1年、3年和5年的生存率分别为88%、82%和75%。左心室舒张末期压力、病变血管数量和双分支阻滞的存在是生存的独立预测因素。根据危险因素对患者进行分层，可识别出预后良好的患者（左心室舒张末期压力<20 mmHg、单支血管病变且无传导障碍者）和其他死亡风险高的患者（左心室舒张末期压力≥20 mmHg、三支血管病变且有双分支阻滞者）。这两组患者5年生存率分别为81%和50%（p<0.005）。
