Haines D E, Beller G A, Watson D D, Nygaard T W, Craddock G B, Cooper A A, Gibson R S
J Am Coll Cardiol. 1985 Nov;6(5):995-1003. doi: 10.1016/s0735-1097(85)80300-4.
To elucidate the functional and prognostic significance of right ventricular dysfunction after acute inferior wall myocardial infarction, 74 consecutive patients with inferior infarction were prospectively evaluated with gated equilibrium blood pool imaging at rest, submaximal exercise thallium-201 scintigraphy and coronary angiography before hospital discharge. In addition, symptom-limited stress thallium-201 scintigraphy was performed in 61 patients at 3 months, and all patients were followed up clinically for 23 +/- 15 months. Utilizing predetermined radionuclide angiographic criteria, 47 patients (Group I) had normal right ventricular function, 12 patients (Group II) had mild to moderate dysfunction and 15 patients (Group III) had severe right ventricular dysfunction. There were no significant differences among the groups with regard to age, history of prior myocardial infarction, peak creatine kinase values, maximal Killip functional class, number or type of in-hospital complications, left ventricular ejection fraction, prevalence of multivessel disease or the distribution and severity of disease affecting the infarct-related vessel. Exercise tolerance as assessed by treadmill time, blood pressure-heart rate product and peak work load in METS was comparable among the three groups, both before hospital discharge and at 3 month follow-up. No differences in indicators of exercise-induced ischemia were noted among the groups, including the prevalence of redistribution thallium-201 defects, ST segment depression or symptoms of chest pain. Finally, cardiac mortality, reinfarction rate and the incidence of medically refractory angina pectoris were similar in the three groups. Thus, right ventricular dysfunction after acute inferior wall myocardial infarction does not appear to limit exercise tolerance or identify a subgroup of patients at higher risk for recurrent cardiac events.
为阐明急性下壁心肌梗死后右心室功能障碍的功能及预后意义，对74例连续的下壁梗死患者在出院前进行了静息门控平衡血池显像、次极量运动铊-201心肌显像及冠状动脉造影的前瞻性评估。此外，61例患者在3个月时进行了症状限制的运动铊-201心肌显像，所有患者均进行了23±15个月的临床随访。根据预定的放射性核素血管造影标准，47例患者（第一组）右心室功能正常，12例患者（第二组）有轻度至中度功能障碍，15例患者（第三组）有严重右心室功能障碍。三组在年龄、既往心肌梗死病史、肌酸激酶峰值、最大Killip心功能分级、院内并发症的数量或类型、左心室射血分数、多支血管病变的患病率或影响梗死相关血管的疾病分布及严重程度方面无显著差异。出院前及3个月随访时，三组通过平板运动时间、血压-心率乘积及代谢当量峰值工作负荷评估的运动耐量相当。三组在运动诱发缺血指标方面无差异，包括铊-201再分布缺损的患病率、ST段压低或胸痛症状。最后，三组的心脏死亡率、再梗死率及药物难治性心绞痛的发生率相似。因此，急性下壁心肌梗死后右心室功能障碍似乎并不限制运动耐量，也不能识别出复发性心脏事件风险较高的患者亚组。
