Bonaduce D, Morgano G, Petretta M, Conforti G, Breglio R, Pace L, Leosco D, Salvatore M
G Ital Cardiol. 1986 Mar;16(3):203-12.
To assess the acute effects of myocardial infarction on right ventricular function 22 patients were studied utilizing right heart catheterization, radionuclide angiography and two dimensional echocardiography. Thirteen patients had inferior myocardial infarction (Group I) and 9 anteroseptal or anterior (Group II). Hemodynamic findings suggesting right ventricular infarction were present in 3 patients of Group I. Mean radionuclide right ventricular ejection fraction was lower in inferior myocardial patients (38.2 +/- 7.6-Group I vs 50.3 +/- 11.4-Group II, p less than 0.005), while left ventricular ejection fraction in anteroseptal, and anterior myocardial infarction patients (36.8 +/- 10.5-Group II vs 55.9 +/- 7.6-Group I, p less than 0.001). Six patients in Group I presented a depressed radionuclide right ventricular ejection fraction (less than 40%): moreover right ventricular ejection fraction correlated with left ventricular ejection fraction in Group II (r = 0.79, p less than 0.001) but not in Group I (r = 0.55, p = NS). By mean of 2 dimensional echocardiography Group I patients had an increased right ventricular end diastolic area (15.3 +/- 3.8 vs 12.1 +/- 1.2 cm2, p less than 0.05) while Group II an increased right ventricular free wall motion (47.3 +/- 10.7 vs 32.4 +/- 14.1%, p less than 0.005); right ventricular end diastolic area correlated with right ventricular ejection fraction only in Group I (r = 0.60, p less than 0.05). Five patients in Group I and no patients in Group II had an enlarged right ventricular end diastolic area. Therefore, radionuclide and echocardiographic evidence of right ventricular involvement were not always associated with abnormal hemodynamics. Thus, the damaged right ventricular chamber dilates to allow an adequate stroke volume in presence of low ejection fraction; hemodynamic significant right ventricular myocardial infarction becomes evident only in patients with more severe right ventricular compromise; the increase in right ventricular free wall motion in anterior myocardial infarction patients compensates the loss of contribution of interventricular septum contraction.
为评估心肌梗死对右心室功能的急性影响，对22例患者进行了研究，采用了右心导管检查、放射性核素血管造影和二维超声心动图。13例患者为下壁心肌梗死（第一组），9例为前间隔或前壁心肌梗死（第二组）。第一组中有3例患者存在提示右心室梗死的血流动力学表现。下壁心肌梗死患者的平均放射性核素右心室射血分数较低（第一组为38.2±7.6，第二组为50.3±11.4，p＜0.005），而前间隔和前壁心肌梗死患者的左心室射血分数（第二组为36.8±10.5，第一组为55.9±7.6，p＜0.001）。第一组中有6例患者放射性核素右心室射血分数降低（＜40%）：此外，第二组中右心室射血分数与左心室射血分数相关（r = 0.79，p＜0.001），而第一组中则不相关（r = 0.55，p = 无显著性差异）。通过二维超声心动图检查，第一组患者的右心室舒张末期面积增加（15.3±3.8 vs 12.1±1.2 cm²，p＜0.05），而第二组患者的右心室游离壁运动增加（47.3±10.7 vs 32.4±14.1%，p＜0.005）；仅在第一组中，右心室舒张末期面积与右心室射血分数相关（r = 0.60，p＜0.05）。第一组中有5例患者右心室舒张末期面积增大，第二组中无患者出现这种情况。因此，右心室受累的放射性核素和超声心动图证据并不总是与异常血流动力学相关。因此，在射血分数较低的情况下，受损的右心室腔会扩张以允许足够的每搏量；血流动力学上有显著意义的右心室心肌梗死仅在右心室受损更严重的患者中才明显；前壁心肌梗死患者右心室游离壁运动的增加补偿了室间隔收缩贡献的损失。
