心肌梗死后发生左心室室壁瘤患者的左心室功能及心肌存活性研究。内科与外科治疗的对比研究。

Study of left ventricular function and myocardial viability in patients with left ventricular aneurysm developed after myocardial infarction. A comparative study of medical and surgical therapy.

作者信息

Yabe Y, Yamashita T, Komatsu H, Koyama N, Ito N, Kamegai T

出版信息

Jpn Heart J. 1985 Jan;26(1):53-68. doi: 10.1536/ihj.26.53.

DOI:10.1536/ihj.26.53

Abstract

We evaluated the treatment of left ventricular aneurysm (LVA) caused by myocardial infarction in 44 patients showing cineangiographical features of left ventricular aneurysm. Of the 44 patients, 28 were treated non-surgically (N-S) and 16 were treated surgically (S). Combined aortocoronary bypass graft (ACBG) with aneurysmectomy was performed on 10 patients. Clinical symptoms in LVA patients were angina (34%), congestive heart failure (31.8%), arrhythmia (29.5%), mitral regurgitation (9%), embolism (4%) and septal perforation (2.3%). Distribution of coronary arterial lesions were single vessel (isolated LAD) 29.5% and multiple vessel 59%. Parameters of LV performance measured at baseline in all LVA patients were: CI 3.05 +/- 0.64 L/min/m2, LVEDP 19.0 +/- 3.5 mmHg, LVEDV 200.6 +/- 25.9 ml, diast. wall stress 50.7 +/- 16.8 g/cm2, EF 0.46 +/- 0.15, LV dp/dt/p 17.8 +/- 2.1 S-1, SWI 61 +/- 24 gm/m2. LV performance after surgery showed clear decreases in LVEDP, LVEDV and wall stress (p less than 0.05, p less than 0.02 and p less than 0.02, respectively). In contrast, EF, LV dp/dt/p and SWI increased significantly (p less than 0.02, p less than 0.1 and p less than 0.01, respectively). Comparison of the results of restudy with first catheterization data in the N-S group showed decreases of EF, contractility index and LV dp/dt/p, each reaching p less than 0.1. Residual myocardial motion 1 year after the first cineangiographic study showed a significant decrease (-12.8 +/- 26.7%) in the N-S group, whereas in the S group it significantly increased to (+60.4 +/- 52.7%). A significant difference in coefficient of variation between N-S and S groups was found. Thus, it can be concluded that aneurysmectomy or concomitant myocardial revascularization with aneurysmectomy improves left ventricular diastolic performance and increases residual myocardial viability.

摘要

我们评估了44例具有左心室室壁瘤血管造影特征的心肌梗死所致左心室室壁瘤（LVA）患者的治疗情况。44例患者中，28例接受非手术治疗（N-S），16例接受手术治疗（S）。10例患者接受了主动脉冠状动脉搭桥术（ACBG）联合室壁瘤切除术。LVA患者的临床症状为心绞痛（34%）、充血性心力衰竭（31.8%）、心律失常（29.5%）、二尖瓣反流（9%）、栓塞（4%）和室间隔穿孔（2.3%）。冠状动脉病变分布为单支血管（孤立的左前降支）29.5%，多支血管59%。所有LVA患者基线时测量的左心室功能参数为：心脏指数（CI）3.05±0.64L/min/m²，左心室舒张末期压力（LVEDP）19.0±3.5mmHg，左心室舒张末期容积（LVEDV）200.6±25.9ml，舒张期壁应力50.7±16.8g/cm²，射血分数（EF）0.46±0.15，左心室dp/dt/p 17.8±2.1S⁻¹，心肌做功指数（SWI）61±24gm/m²。手术后左心室功能显示LVEDP、LVEDV和壁应力明显降低（分别为p<0.05、p<0.02和p<0.02）。相比之下，EF、左心室dp/dt/p和SWI显著增加（分别为p<0.02、p<0.1和p<0.01）。N-S组再次研究结果与首次心导管检查数据比较显示EF、收缩性指数和左心室dp/dt/p降低，均达到p<0.1。首次心血管造影研究1年后，N-S组残余心肌运动显著降低（-12.8±26.7%），而S组则显著增加至（+60.4±52.7%）。发现N-S组和S组变异系数有显著差异。因此，可以得出结论，室壁瘤切除术或室壁瘤切除术联合心肌血运重建可改善左心室舒张功能并增加残余心肌活力。