Ejiri M, Fujita M, Sakai O, Miwa K, Asanoi H, Sasayama S
Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University.
J Cardiol. 1990;20(1):31-7.
The present study evaluated the effects of coronary collateral circulation developing after acute myocardial infarction on global and regional left ventricular function during the chronic stage. The study group consisted of 16 patients with initial myocardial infarction having total occlusion of the proximal left anterior descending coronary artery. To eliminate the effects of collateral circulation existing at the onset of infarction, patients with pre-infarction angina were excluded from this study. The patients were categorized in two groups depending on the extent of their collateral circulation (collateral index: CI 0-3): group A--patients with significant collateral circulation (CI = 2 or 3) to the infarct-related coronary artery; group B--patients without significant collateral circulation (CI = 0 or 1). Their heart rate, left ventricular peak systolic and end-diastolic pressures and cardiac index were similar in the two groups. The left ventricular end-systolic volume index in the group B was significantly greater than that in the group A (60 +/- 21 ml/m2 vs 34 +/- 9 ml/m2, p less than 0.05). Left ventricular ejection fraction in the group A was significantly greater than that of the group B (55 +/- 9% vs 39 +/- 15%, p less than 0.05), and a significant difference was observed in the percentage of segment shortening in the infarct area between the groups A and B (10.8 +/- 9.2% vs -0.2 +/- 5.4%, p less than 0.01). It was concluded that coronary collateral circulation which develops after acute myocardial infarction exerts beneficial effects on global and regional left ventricular function during the chronic stage.
本研究评估了急性心肌梗死后形成的冠状动脉侧支循环对慢性期左心室整体和局部功能的影响。研究组由16例最初发生心肌梗死且左前降支近端冠状动脉完全闭塞的患者组成。为消除梗死发作时已存在的侧支循环的影响，本研究排除了梗死前心绞痛患者。根据侧支循环的程度（侧支指数：CI 0 - 3）将患者分为两组：A组——梗死相关冠状动脉有显著侧支循环（CI = 2或3）的患者；B组——无显著侧支循环（CI = 0或1）的患者。两组患者的心率、左心室收缩压峰值、舒张压末期压力和心脏指数相似。B组的左心室收缩末期容积指数显著高于A组（60±21 ml/m² 对34±9 ml/m²，p < 0.05）。A组的左心室射血分数显著高于B组（55±9% 对39±15%，p < 0.05），且A组和B组梗死区域节段缩短百分比存在显著差异（10.8±9.2% 对 -0.2±5.4%，p < 0.01）。得出的结论是，急性心肌梗死后形成的冠状动脉侧支循环在慢性期对左心室整体和局部功能发挥有益作用。
