有或无既往心肌梗死的慢性缺血性心脏病的表现模式。
Patterns of presentation of chronic ischemic heart disease with and without previous myocardial infarction.
作者信息
Ahmad Rehan, Rabbani Aftab, Awan Zahid Aslam
机构信息
Department of Medicine, Ayub Medical College, Abbottabad, Pakistan.
出版信息
J Ayub Med Coll Abbottabad. 2009 Oct-Dec;21(4):143-5.
BACKGROUND
The prevalence of Ischemic Heart Disease (IHD) is on the rise, from increasing lifespan of population and availability of better medical facilities. We studied chronic IHD cases with and without previous myocardial infarction, in Hazara, NWFP, Pakistan to evaluate left ventricular (LV) dysfunction, wall motion abnormalities and complications of IHD.
METHODS
All patients presenting with history of chest pain in Medical 'C' Unit, Ayub Teaching Hospital, Abbottabad from June 2004 to May 2005 were included in the study. Patients with non-cardiac chest pain were excluded from the study. Cases with congenital and rheumatic heart disease, cardiomyopathies, unstable angina and acute MI were excluded. Patients with IHD with or without myocardial infarction (MI) were studied for left ventricular dysfunction (ejection fraction, left atrial size, E/A ratio), wall motion abnormalities and complications of IHD (Mitral regurgitation, Ventricular Septal Defect (VSD), LV aneurysm, LV clot). Clinical and echocardiographic evaluation was done in each case.
RESULTS
Out of 183 cases of chronic IHD, 123 patients were without previous MI and 60 had had previous MI. Ejection fraction (EF) was 45% +/- 15 in the group without MI and 35 +/- 11% in cases with MI. Left Atrium (LA) size was 35 +/- 6 mm and 39 +/- 4 mm in the two groups respectively. LV diastolic dysfunction was seen in 17% in the first and 24% in the second group respectively. Global hypokinesia was seen in 8% and 17% in the 2 groups respectively. Regional Wall Motion Abrormality (RWMA) was observed in 12% in patients without MI and in 58% cases with MI. Mitral regurgitation was seen in 10 and 20% in the 2 groups respectively LV clots, VSD, LV and aneurysm were seen in 8.4, 5, and 6.5% respectively, only in cases with previous MI.
CONCLUSION
LV dysfunction, wall motion abnormalities and mitral regurgitation were more common in IHD cases with previous heart attack.
背景
由于人口寿命延长以及更好的医疗设施的可及性，缺血性心脏病（IHD）的患病率正在上升。我们在巴基斯坦西北边境省哈扎拉地区研究了有或无既往心肌梗死的慢性IHD病例，以评估左心室（LV）功能障碍、室壁运动异常及IHD的并发症。
方法
纳入2004年6月至2005年5月在阿伯塔巴德阿尤布教学医院内科‘C’病房有胸痛病史的所有患者。非心脏性胸痛患者被排除在研究之外。先天性和风湿性心脏病、心肌病、不稳定型心绞痛及急性心肌梗死患者被排除。对有或无心肌梗死（MI）的IHD患者进行左心室功能障碍（射血分数、左心房大小、E/A比值）、室壁运动异常及IHD并发症（二尖瓣反流、室间隔缺损（VSD）、左心室动脉瘤、左心室血栓）的研究。对每例患者进行临床和超声心动图评估。
结果
在183例慢性IHD病例中，123例患者无既往心肌梗死，60例有既往心肌梗死。无心肌梗死组的射血分数（EF）为45%±15%，有心肌梗死组为35%±11%。两组的左心房（LA）大小分别为35±6mm和39±4mm。第一组和第二组左心室舒张功能障碍的发生率分别为17%和24%。两组中整体运动减弱的发生率分别为8%和17%。无心肌梗死患者中区域室壁运动异常（RWMA）的发生率为12%，有心肌梗死患者中为58%。二尖瓣反流在两组中的发生率分别为10%和20%。仅在有既往心肌梗死的病例中，左心室血栓、室间隔缺损、左心室和动脉瘤的发生率分别为8.4%、5%和6.5%。
结论
既往有心脏病发作的IHD病例中，左心室功能障碍、室壁运动异常和二尖瓣反流更为常见。
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