Strasberg B, Pinchas A, Arditti A, Lewin R F, Sclarovsky S, Hellman C, Zafrir N, Agmon J
Am J Cardiol. 1984 Nov 1;54(8):985-7. doi: 10.1016/s0002-9149(84)80130-7.
Of 139 consecutive patients with a first inferior acute myocardial infarction, 26 (19%) had advanced atrioventricular (AV) block and 113 (81%) did not. All were evaluated by 2-dimensional echocardiography (2-D echo) and radionuclide angiography. Patients with advanced AV block had lower radionuclide left ventricular (LV) ejection fraction (51 +/- 10 vs 58 +/- 11%, p less than 0.01), higher LV wall motion score on 2-D echo (5.6 +/- 2.6 vs 3.1 +/- 2.7, p less than 0.001), lower radionuclide right ventricular (RV) ejection fraction (32 +/- 15 vs 39 +/- 16%, p less than 0.001) and higher RV wall motion score on 2-D echo (3.4 +/- 1.7 vs 1.5 +/- 2, p less than 0.002) than did patients without AV block. The incidence rate of RV dysfunction was higher in patients with advanced AV block (78 vs 40%, p less than 0.02), and the mortality rate was also higher (although not significantly) in patients with advanced AV block (15 vs 6%). In conclusion, patients with inferior acute myocardial infarction and advanced AV block have larger infarct sizes (as seen on radionuclide angiography and 2-D echo) and lower RV and LV function than patients without AV block. This finding may explain the higher mortality rate observed in this group.
在139例连续的首次发生下壁急性心肌梗死的患者中，26例（19%）发生了高度房室传导阻滞，113例（81%）未发生。所有患者均接受了二维超声心动图（2-D echo）和放射性核素血管造影检查。发生高度房室传导阻滞的患者放射性核素左心室（LV）射血分数较低（51±10%对58±11%，p<0.01），二维超声心动图上的左心室壁运动评分较高（5.6±2.6对3.1±2.7，p<0.001），放射性核素右心室（RV）射血分数较低（32±15%对39±16%，p<0.001），二维超声心动图上的右心室壁运动评分较高（3.4±1.7对1.5±2，p<0.002），与未发生房室传导阻滞的患者相比。高度房室传导阻滞患者右心室功能障碍的发生率较高（78%对40%，p<0.02），高度房室传导阻滞患者的死亡率也较高（尽管不显著）（15%对6%）。总之，与未发生房室传导阻滞的患者相比，下壁急性心肌梗死并发生高度房室传导阻滞的患者梗死面积更大（放射性核素血管造影和二维超声心动图所见），右心室和左心室功能更低。这一发现可能解释了该组观察到的较高死亡率。
