Jugdutt B I, Haraphongse M, Basualdo C A, Rossall R E
Am Heart J. 1984 Dec;108(6):1417-26. doi: 10.1016/0002-8703(84)90686-0.
Hypotension in inferior myocardial infarction (IMI) may be due to extensive involvement of the right ventricle (RV), left ventricle (LV), or both. We verified this hypothesis in 24 patients with IMI and hypotension (systolic blood pressure less than 100 mm Hg), within 48 hours of admission, by means of two-dimensional echocardiography (2DE). We measured the extent of regional RV and LV asynergy (akinesis and/or dyskinesis) in parasternal short-axis sections at mitral, chordal, midpapillary muscle, and low papillary muscle levels. Initial right heart catheterization revealed predominant RV dysfunction in 16 patients (group 1) and predominant LV dysfunction in eight patients (group 2). For all patients, the initial 2DE revealed: (1) biventricular asynergy involving the posterior RV, posterior LV, and posterior interventricular septum; (2) a wide range of values for the extent of asynergy (RV 21% to 90%; LV 19% to 48%); and (3) a direct correlation between peak creatine kinase levels and percentage of LV asynergy (r = 0.80, p less than 0.001) or percentage of RV plus LV asynergy (r = 0.72, p less than 0.001). Although the extent of LV asynergy was similar in the two groups (34% vs 34%, NS), the extent of RV asynergy was greater in group 1 than in group 2 (57% vs 30%, p less than 0.001). More important, the ratio of RV/LV asynergy was greater for group 1 than group 2 (1.75 vs 0.89, p less than 0.001), and this difference in ratios between the two groups was also found in 2DE studies at 10 days and 6 months. A RV/LV asynergy ratio value of 1.1 provided clear separation between the groups. Thus, the RV/LV asynergy ratio on an initial 2DE can clarify the clinical syndrome of hypotension in patients with IMI. An increased asynergy ratio might identify those patients with predominant RV involvement.
下壁心肌梗死（IMI）中的低血压可能是由于右心室（RV）、左心室（LV）或两者广泛受累所致。我们在24例入院48小时内患有IMI且伴有低血压（收缩压低于100 mmHg）的患者中，通过二维超声心动图（2DE）验证了这一假设。我们在二尖瓣、腱索、乳头肌中部和乳头肌下部水平的胸骨旁短轴切面测量了右心室和左心室局部运动不协调（运动不能和/或运动障碍）的程度。初始右心导管检查显示，16例患者（第1组）主要为右心室功能障碍，8例患者（第2组）主要为左心室功能障碍。对于所有患者，初始2DE显示：（1）双心室运动不协调累及右心室后壁、左心室后壁和室间隔后部；（2）运动不协调程度的数值范围较广（右心室21%至90%；左心室19%至48%）；（3）肌酸激酶峰值水平与左心室运动不协调百分比（r = 0.80，p < 0.001）或右心室加左心室运动不协调百分比（r = 0.72，p < 0.001）之间存在直接相关性。虽然两组左心室运动不协调程度相似（34%对34%，无显著性差异），但第1组右心室运动不协调程度大于第2组（57%对30%，p < 0.001）。更重要的是，第1组右心室/左心室运动不协调比值大于第2组（1.75对0.89，p < 0.001），并且在10天和6个月的2DE研究中也发现了两组之间的这种比值差异。右心室/左心室运动不协调比值为1.1可将两组明显区分开来。因此，初始2DE上的右心室/左心室运动不协调比值可阐明IMI患者低血压的临床综合征。比值升高可能识别出主要累及右心室的患者。
