Hochman J S, Platia E B, Bulkley B H
Ann Intern Med. 1984 Jan;100(1):29-35. doi: 10.7326/0003-4819-100-1-29.
To correlate morphologic subgroups of left ventricular aneurysms with the major clinical manifestations (ventricular arrhythmias, congestive heart failure, and systemic emboli), we studied 73 patients with such aneurysms--34 at autopsy and 45 after surgical excision. Sixty-three patients had a history of congestive heart failure, 5 had systemic emboli, and 28 had recurrent ventricular tachycardia. Two types of endocardial abnormalities were noted: thick endocardial plaque composed of fibrous elastic tissue that contained little or no thrombus (type I, 30 patients); and aneurysms with little or no endocardial fibroelastosis (type II, 43 patients), some with layers of thrombus obliterating the aneurysmal cavity. Emboli only occurred in 5 patients with type II aneurysms who had mural thrombi. Recurrent ventricular tachycardia occurred in 20 patients with type I aneurysms but only in 8 with type II (p less than 0.001), showing a relation between endocardial fibroelastosis and ventricular tachycardia. Structural differences in ventricular aneurysms thus appear to have pathophysiologic significance. Our findings have implications for the mechanisms of ventricular tachycardia in postinfarction patients and for its prevention by endocardial resection.
为了将左心室室壁瘤的形态学亚组与主要临床表现（室性心律失常、充血性心力衰竭和全身性栓塞）相关联，我们研究了73例患有此类室壁瘤的患者——34例经尸检，45例经手术切除。63例患者有充血性心力衰竭病史，5例有全身性栓塞，28例有反复发作的室性心动过速。观察到两种类型的心内膜异常：由纤维弹性组织组成的增厚的心内膜斑块，几乎不含或不含血栓（I型，30例患者）；以及几乎没有或没有心内膜纤维弹性组织的室壁瘤（II型，43例患者），有些有血栓层闭塞瘤腔。仅在5例有壁血栓的II型室壁瘤患者中发生栓塞。20例I型室壁瘤患者出现反复发作的室性心动过速，但II型仅8例（p<0.001），表明心内膜纤维弹性组织与室性心动过速之间存在关联。因此，室壁瘤的结构差异似乎具有病理生理学意义。我们的发现对心肌梗死后患者室性心动过速的机制及其通过心内膜切除术的预防具有启示意义。
