Piérard L A, Albert A, Gilis F, Sprynger M, Carlier J, Kulbertus H E
Am J Cardiol. 1987 Jul 1;60(1):5-9. doi: 10.1016/0002-9149(87)90973-8.
To identify patients at risk of cardiac expansion during hospital stay for a first acute myocardial infarction (AMI), 41 patients underwent right-sided cardiac catheterization soon after admission and serial 2-dimensional echocardiography on days 1, 3 or 4 and between days 7 and 10. Infarct expansion was recognized by echocardiography in 11 patients (27%), most often on the second recording (day 3 or 4). Age, sex, time from onset of pain to catheterization, peak levels of creatine kinase and creatine kinase-MB isoenzyme, heart rate, mean pulmonary artery wedge pressure and left ventricular stroke work index were similar in the 2 groups. Patients in whom infarct expansion developed had a higher incidence of previous systemic hypertension (73% vs 27%, p less than 0.01) and anterior AMI (91% vs 30%, p less than 0.001) and a higher mortality rate at 1 year (73 vs 7%, p less than 0.001) than those who did not. They also had higher systolic (139 +/- 24 vs 126 +/- 18 mm Hg, p less than 0.05) and diastolic (91 +/- 14 vs 75 +/- 13 mm Hg, p less than 0.001) arterial pressures, lower stroke volume index (31 +/- 10 vs 40 +/- 10 ml/m2, p less than 0.01) and much higher systemic vascular resistance (SVR) values (1,713 +/- 380 vs 1,253 +/- 264 dynes s cm-5, p less than 0.0001). In the subgroups of patients with anterior AMI, differences were significant for diastolic arterial pressure, stroke volume index, SVR and mortality.(ABSTRACT TRUNCATED AT 250 WORDS)
为了识别首次急性心肌梗死（AMI）住院期间有心脏扩大风险的患者，41例患者在入院后不久接受了右侧心导管检查，并在第1、3或4天以及第7至10天之间进行了系列二维超声心动图检查。11例患者（27%）通过超声心动图发现有梗死扩展，最常见于第二次检查时（第3或4天）。两组患者的年龄、性别、疼痛发作至导管检查的时间、肌酸激酶和肌酸激酶-MB同工酶的峰值水平、心率、平均肺动脉楔压和左心室每搏功指数相似。发生梗死扩展的患者既往系统性高血压的发生率（73% 对27%，p<0.01）和前壁AMI的发生率（91% 对30%，p<0.001）高于未发生梗死扩展的患者，且1年死亡率（73% 对7%，p<0.001）也更高。他们的收缩压（139±24对126±18 mmHg，p<0.05）和舒张压（91±14对75±13 mmHg，p<0.001）也更高，每搏量指数更低（31±10对40±10 ml/m²，p<0.01），全身血管阻力（SVR）值高得多（1713±380对1253±264 dynes s cm⁻⁵，p<0.0001）。在前壁AMI患者亚组中，舒张压、每搏量指数、SVR和死亡率的差异具有统计学意义。（摘要截断于250字）
