Iliceto S, Caiati C, Ricci A, Amico A, D'Ambrosio G, Ferri G M, Izzi M, Lagioia R, Rizzon P
Division of Cardiology, University of Bari, Italy.
Int J Cardiol. 1990 Jul;28(1):95-103. doi: 10.1016/0167-5273(90)90013-u.
Atrial pacing can safely be utilized shortly after myocardial infarction. To evaluate the prognostic value of wall motion abnormalities induced by such pacing 83 consecutive patients with recent uncomplicated myocardial infarction underwent transthoracic cross-sectional echocardiography during transesophageal atrial pacing and upright bicycle exercise stress test. Patients were followed-up for 14 +/- 5 months. During the atrial pacing and the echocardiography, patients were defined at high risk if abnormalities of wall motion were detected in left ventricular regions remote from the infarcted area. Then, during the exercise stress test, high risk patients were those with ST segment depression greater than or equal to 1 mm. On the other hand, patients were considered to be at low risk if they had no abnormalities of wall motion during atrial pacing in remote regions or, in the case of the stress test, if they did not develop ST depression greater than or equal to 1 mm. Of the 83 patients, 21 had major cardiac events during the period of follow-up. Cardiac events occurred in 15/23 (65%) and 5/60 (8%, P less than 0.001) patients assigned to the groups adjudged to be at high and low risk, respectively, on the basis of echocardiographic results. Exercise testing was less reliable in identifying patients at risk of future cardiac events. Major events occurred in only 6 of the 19 patients with a positive stress test (32%, P less than 0.05 vs positive stress echocardiography) and in 14 of the 64 patients with a negative exercise stress test (22%, P = NS vs positive exercise stress test, P less than 0.05 vs negative atrial pacing echocardiography).
心肌梗死后不久即可安全地进行心房起搏。为评估这种起搏诱发的室壁运动异常的预后价值，83例近期发生无并发症心肌梗死的患者在经食管心房起搏及直立位踏车运动负荷试验期间接受了经胸横断面超声心动图检查。患者随访14±5个月。在心房起搏及超声心动图检查期间，如果在远离梗死区域的左心室区域检测到室壁运动异常，则将患者定义为高危。然后，在运动负荷试验期间，高危患者是指ST段压低≥1mm的患者。另一方面，如果患者在心房起搏时远离区域无室壁运动异常，或者在负荷试验时未出现ST段压低≥1mm，则被认为是低危患者。83例患者中，21例在随访期间发生了主要心脏事件。根据超声心动图结果，分别被判定为高危和低危组的患者中，心脏事件发生在15/23（65%）和5/60（8%，P<0.001）的患者中。运动试验在识别未来有心脏事件风险的患者方面可靠性较差。19例运动负荷试验阳性的患者中仅6例发生主要事件（32%，与运动负荷超声心动图阳性相比P<0.05），64例运动负荷试验阴性的患者中有14例发生主要事件（22%，与运动负荷试验阳性相比P=无显著性差异，与心房起搏超声心动图阴性相比P<0.05）。
