Giannuzzi P, Giordano A, Tavazzi L
G Ital Cardiol. 1984 Oct;14(10):735-44.
Recently we proposed a topographical classification of myocardial infarction (MI) based on the site and extension of left ventricular asynergy (AS) detected by Two-dimensional Echocardiography (2D ECHO) at rest: a) Anterior MI: 1) apical MI with AS of apical segments only, 2) apico-septal MI with AS of apex and septum, 3) apico-septo-lateral MI with involvement of septum, apex and antero-lateral wall. b) Inferior MI: 1) isolated inferior MI with involvement of infero-dorsal wall segments; 2) infero-apical MI with AS of inferior wall and apex, 3) infero-apico-septal MI with kinetic abnormalities of inferior wall, apex and septum and finally c) antero-inferior MI with large AS of septum, apex, antero-lateral and inferior wall. In order to validate the functional significance of this classification, 2D ECHO at rest and symptom limited bicycle ergometric test (E) in supine position with EC-Graphic and hemodynamic monitoring (Swan-Ganz cath.), were performed in the same day within two months after a first transmural MI, in 259 patients, I-II NYHA classes. Among anterior MIs, diastolic pulmonary arterial pressure (PAedP) at rest was normal and similar in apical and apico-septal MIs (11 +/- 3 mmHg). It was significantly (p less than .001) higher 14 +/- 5 mmHg in apico-septo-lateral MIs. Left ventricular stroke work index (LVSWI) was higher in apical MIs (55 +/- 14) than in apico-septal (47 +/- 12, p less than .01) and in apico-septo-lateral MIs (38 +/- 9, p less than .001). Maximal work load during E was 86 +/- 31 watt in apical MIs, 77 +/- 29 watt in apico-septal MIs and 70 +/- 25 in apico-septo-lateral MIs with significant difference (p less than .05) only between the last ones and apical MIs. The PAedP during E was normal (20 +/- 7 mmHg) in apical MI, but increased abnormally in apico-septal (24 +/- 7 mmHg) and in apico-septo-lateral (27 +/- 7 mmHg) with a significant difference (p less than .01) only between apical and apico-septo-lateral MIs. In inferior MIs, hemodynamic data at rest were similar in pts with isolated inferior, infero-apical and infero-apico-septal MIs. Maximal work load, similar in inferior and infero-apical MI (88 +/- 30 W) was higher (p less than .01) than in infero-apico-septal (68 +/- 22W).(ABSTRACT TRUNCATED AT 400 WORDS)
最近，我们基于静息状态下二维超声心动图（2D ECHO）检测到的左心室运动不协调（AS）的部位和范围，提出了一种心肌梗死（MI）的地形学分类方法：a）前壁心肌梗死：1）仅心尖段存在AS的心尖部心肌梗死；2）心尖和室间隔存在AS的心尖 - 室间隔心肌梗死；3）累及室间隔、心尖和前侧壁的心尖 - 室间隔 - 侧壁心肌梗死。b）下壁心肌梗死：1）仅累及下后壁节段的孤立性下壁心肌梗死；2）下壁和心尖存在AS的下壁 - 心尖心肌梗死；3）下壁、心尖和室间隔存在运动异常的下壁 - 心尖 - 室间隔心肌梗死，最后c）室间隔、心尖、前侧壁和下壁存在大面积AS的前壁 - 下壁心肌梗死。为了验证这种分类的功能意义，在259例I - II级纽约心脏协会（NYHA）分级的患者中，于首次透壁性心肌梗死后两个月内的同一天，进行了静息状态下的2D ECHO检查以及仰卧位症状限制性自行车测力计试验（E），同时进行心电图（ECG）和血流动力学监测（Swan - Ganz导管）。在前壁心肌梗死中，静息状态下舒张期肺动脉压（PAedP）正常，心尖部和心尖 - 室间隔心肌梗死相似（11±3 mmHg）。在心尖 - 室间隔 - 侧壁心肌梗死中显著更高（14±5 mmHg，p＜0.001）。左心室每搏功指数（LVSWI）在心尖部心肌梗死中（55±14）高于心尖 - 室间隔心肌梗死（47±12，p＜0.01）和心尖 - 室间隔 - 侧壁心肌梗死（38±9，p＜0.001）。运动试验期间的心尖部心肌梗死最大工作负荷为86±31瓦，心尖 - 室间隔心肌梗死为77±29瓦，心尖 - 室间隔 - 侧壁心肌梗死为70±25瓦，仅最后一组与心尖部心肌梗死之间存在显著差异（p＜0.05）。运动试验期间心尖部心肌梗死的PAedP正常（20±7 mmHg），但在心尖 - 室间隔心肌梗死（24±7 mmHg）和心尖 - 室间隔 - 侧壁心肌梗死（27±7 mmHg）中异常升高，仅心尖部与心尖 - 室间隔 - 侧壁心肌梗死之间存在显著差异（p＜0.01）。在下壁心肌梗死中，孤立性下壁、下壁 - 心尖和下壁 - 心尖 - 室间隔心肌梗死患者的静息血流动力学数据相似。下壁心肌梗死和下壁 - 心尖心肌梗死的最大工作负荷相似（88±30瓦），高于下壁 - 心尖 - 室间隔心肌梗死（68±22瓦，p＜0.01）。（摘要截断于400字）
