Leung W H, Lau C P
Cardiology Division, Stanford University School of Medicine, California.
J Am Coll Cardiol. 1992 Aug;20(2):307-13. doi: 10.1016/0735-1097(92)90095-5.
This study was designed to evaluate the relation between the severity of the residual stenosis of the infarct-related artery and changes in left ventricular volume and function after a first anterior myocardial infarction.
Although thrombolytic therapy improves clinical outcome after acute myocardial infarction, the relations between the severity of the residual stenosis of the infarct-related artery and postinfarction left ventricular remodeling and function are unclear.
Fifty-eight patients with a first anterior myocardial infarction and significant disease only in the left anterior descending coronary artery on arteriography performed after 7 to 10 days were evaluated. All patients received thrombolytic therapy. Residual stenosis of the infarct-related artery was measured with quantitative coronary arteriography. Left ventricular volumes and ejection fraction were measured by echocardiography and radionuclide angiography, respectively, 7 to 10 days, 6 months and 1 year after infarction. End-diastolic and end-systolic left ventricular volumes were measured by two-dimensional echocardiography and normalized to body surface area. Patients were classified into three groups according to baseline residual stenosis severity: total occlusion (Group I), minimal lesion diameter less than 1.5 mm (Group II) and minimal diameter greater than or equal to 1.5 mm (Group III).
Group I patients had significantly greater left ventricular end-diastolic and end-systolic volumes at 6 months and 1 year than did the other groups. Group II patients had greater end-diastolic and end-systolic volumes than did Group III patients at 1 year. In addition, Group I patients had a lower ejection fraction at 1 year than that of the other groups. The minimal lesion diameter was significantly correlated with percent change in end-diastolic volume at 1 year.
The severity of the baseline residual stenosis of the infarct-related artery is an important predictor of change in left ventricular volumes in the 1st year after infarction. Total occlusion of the infarct-related artery is associated with greater left ventricular dilation and functional impairment.
本研究旨在评估首次前壁心肌梗死后梗死相关动脉残余狭窄的严重程度与左心室容积及功能变化之间的关系。
尽管溶栓治疗可改善急性心肌梗死后的临床结局，但梗死相关动脉残余狭窄的严重程度与梗死后左心室重构及功能之间的关系尚不清楚。
对58例首次前壁心肌梗死且在7至10天后进行的血管造影显示仅左前降支冠状动脉有明显病变的患者进行评估。所有患者均接受溶栓治疗。通过定量冠状动脉造影测量梗死相关动脉的残余狭窄。分别在梗死后7至10天、6个月和1年，通过超声心动图和放射性核素血管造影测量左心室容积和射血分数。通过二维超声心动图测量舒张末期和收缩末期左心室容积，并将其标准化为体表面积。根据基线残余狭窄严重程度将患者分为三组：完全闭塞（I组）、最小病变直径小于1.5 mm（II组）和最小直径大于或等于1.5 mm（III组）。
I组患者在6个月和1年时的左心室舒张末期和收缩末期容积明显大于其他组。II组患者在1年时的舒张末期和收缩末期容积大于III组患者。此外，I组患者在1年时的射血分数低于其他组。最小病变直径与1年时舒张末期容积的变化百分比显著相关。
梗死相关动脉基线残余狭窄的严重程度是梗死后第1年左心室容积变化的重要预测指标。梗死相关动脉完全闭塞与更大的左心室扩张和功能损害相关。
