Division of Cardiology, Buddhist Tzu Chi General Hospital, Taipei Branch, Taiwan.
Am J Med Sci. 2011 Dec;342(6):474-9. doi: 10.1097/MAJ.0b013e3182198686.
To investigate the effect of different infarction sites on right ventricular (RV) functional changes in patients with a first acute ST-elevation myocardial infarction without concomitant RV infarction.
Sixty consecutive patients underwent conventional echocardiography and pulsed-wave tissue Doppler imaging for RV function evaluation after successful primary percutaneous coronary intervention. They were divided into 2 groups according to infarct location based on the electrocardiographic findings: group I consisted of 35 patients with anterior (including anteroseptal) wall infarction and group II included 25 patients with inferior (including inferoposterior) wall infarction. Ten healthy individuals served as the control group.
The tricuspid annular plane systolic excursion was significantly lower in group I compared with that in the controls (20.3 ± 3.8 versus 23.9 ± 2.4 mm, P < 0.05). The ratio of transtricuspid peak early filling velocity to tricuspid annular early diastolic velocity (E/E(m)) was comparable between group I and group II, whereas it was higher in group II than in the controls (6.10 ± 1.37 versus 4.33 ± 1.17, P < 0.05). The RV myocardial performance index determined by tissue Doppler imaging was significantly higher in group I than in group II (0.48 ± 0.25 versus 0.32 ± 0.10, P < 0.05) and the healthy controls (0.48 ± 0.25 versus 0.27 ± 0.08, P < 0.05).
In patients with a first, acute reperfused ST-elevation myocardial infarction without associated RV infarction, RV function may be affected discrepantly depending on the different infarction sites. In patients with inferior infarction without concomitant RV infarction, only regional RV diastolic dysfunction is observed, whereas the alteration of global RV function is more pronounced in patients with anterior wall infarction.
本研究旨在探讨首次急性 ST 段抬高型心肌梗死患者中不同梗死部位对右心室（RV）功能变化的影响，这些患者均未合并 RV 梗死。
连续纳入 60 例接受直接经皮冠状动脉介入治疗成功的患者，所有患者均在术后进行常规超声心动图和组织多普勒成像脉冲波检查以评估 RV 功能。根据心电图结果将患者分为 2 组：组 I （35 例）包括前壁（包括前间隔）梗死，组 II （25 例）包括下壁（包括下后壁）梗死。另选择 10 例健康个体作为对照组。
与对照组相比，组 I 的三尖瓣环平面收缩期位移明显降低（20.3 ± 3.8 比 23.9 ± 2.4 mm，P < 0.05）。组 I 和组 II 的三尖瓣瓣环收缩期早期峰值速度与三尖瓣瓣环舒张早期速度的比值（E/E(m)）无显著差异，而该比值均高于对照组（6.10 ± 1.37 比 4.33 ± 1.17，P < 0.05）。组织多普勒成像测定的 RV 心肌运动指数在组 I 中显著高于组 II（0.48 ± 0.25 比 0.32 ± 0.10，P < 0.05）和对照组（0.48 ± 0.25 比 0.27 ± 0.08，P < 0.05）。
在首次急性再灌注 ST 段抬高型心肌梗死且未合并 RV 梗死的患者中，不同梗死部位可能导致 RV 功能出现不同程度的改变。下壁梗死且未合并 RV 梗死的患者仅出现 RV 局部舒张功能障碍，而前壁梗死的患者 RV 整体功能改变更为明显。
