Shen W
Rui Jin Hospital, Shanghai Second Medical University.
Zhonghua Xin Xue Guan Bing Za Zhi. 1990 Dec;18(6):327-30, 381.
The relation of left ventricular (LV) volume changes to clinical and angiographic features was assessed in 57 patients with a first transmural myocardial infarction. LV volumes were measured by two-dimensional echocardiography within 72 hours of admission and repeated at one month. The infarct-related artery (IRA) patency and collateral circulation were determined by coronary arteriography performed before discharge. LV end-diastolic and end-systolic volumes increased (155 +/- 44 vs 203 +/- 65 ml; 96 +/- 32 vs 134 +/- 57 ml, all P less than 0.01), and ejection fraction decreased (0.38 +/- 0.06 vs 0.34 +/- 0.09, P less than 0.05) in patients with totally occluded IRA without collaterals. In contrast, LV volumes and systolic function were unchanged in those who had subtotally occluded IRA or with collaterals. LV dilation (greater than or equal to 20% increase in LV end-diastolic volume) occurred more frequently in patients without residual flow to the infarct region (77%) than in those with (9%) (P less than 0.01). Thirteen patients with LV dilation developed congestive heart failure, 3 of whom having cardiac death. However, congestive heart failure was found in only 11 patients without LV dilation and no death occurred. Thus, the cardiac event rate was higher in patients with (65%) than in those without (30%) LV dilation (P less than 0.05). The study indicates that the changes in LV volumes following acute myocardial infarction are largely related to the status of residual flow to the infarct region and affect the clinical outcome of the patients.
在57例首次透壁性心肌梗死患者中，评估了左心室（LV）容积变化与临床及血管造影特征的关系。在入院72小时内通过二维超声心动图测量LV容积，并在1个月时重复测量。出院前通过冠状动脉造影确定梗死相关动脉（IRA）通畅情况及侧支循环。IRA完全闭塞且无侧支循环的患者，LV舒张末期和收缩末期容积增加（分别为155±44 vs 203±65 ml；96±32 vs 134±57 ml，均P<0.01），射血分数降低（0.38±0.06 vs 0.34±0.09，P<0.05）。相比之下，IRA次全闭塞或有侧支循环的患者，LV容积和收缩功能无变化。LV扩张（LV舒张末期容积增加≥20%）在梗死区域无残余血流的患者中更常见（77%），而在有残余血流的患者中较少见（9%）（P<0.01）。13例LV扩张患者发生充血性心力衰竭，其中3例死亡。然而，在无LV扩张的患者中仅发现11例充血性心力衰竭，且无死亡发生。因此，有LV扩张的患者心脏事件发生率（65%）高于无LV扩张的患者（30%）（P<0.05）。该研究表明，急性心肌梗死后LV容积的变化在很大程度上与梗死区域的残余血流状态有关，并影响患者的临床结局。
