Nemerovski M, Shah P K, Pichler M, Berman D S, Shellock F, Swan H J
Am Heart J. 1982 Oct;104(4 Pt 1):709-17. doi: 10.1016/0002-8703(82)90001-1.
The purpose of this study was to define the sequential changes in left and right ventricular ejection fraction (LVEF, RVEF) and regional LV wall motion following first transmural acute myocardial infarction (AMI). Fifty-four patients with either anterior (n = 28) or inferior (n = 26) infarction underwent radionuclide ventriculography (RNV) within 48 hours of onset of chest pain (study 1), between days 3 and 6 (study 2), and again between days 7 and 25 (study 3). Twenty-six of the patients with anterior MI (93%) had initial LVEF less than 0.54, compared with 13 of 26 patients (50%) with inferior MI (p less than 0.01). Eleven of 26 patients (42.3%) with inferior MI had initial RVEF less than 0.39, compared with 8 of 27 patients (29.6%) with anterior MI (p less than 0.01). There were no overall significant serial changes in mean LVEF or mean RVEF in patients with either anterior or inferior MI. From study 1 to study 2, LVEF did not change in 24 patients (44%), improved in 13 (24%), and worsened in 17 (31%). From study 1 to study 3, LVEF remained unchanged in 15 patients (35%), improved in 17 (39%), and worsened in 11 (26%). From study 1 to study 2, RVEF did not change in 25 of 51 patients (49%), improved in 17 (31%), and worsened in 9 (17%). From study 1 to study 3, RVEF remained unchanged in 14 (38%), improved in 18 (48%), and worsened in five (14%). Changes in EF tended to occur early in the hospital course, with little subsequent changes. Serial changes in EF could not be predicted by clinical or demographic variables or by location of infarction. Significant changes in LVEF typically occurred without concurrent change in regional LV wall motion, suggesting alteration in ventricular loading rather than change in intrinsic myocardial performance. Initial depression of LVEF correlated with in-hospital mortality as well as with development of congestive heart failure and conduction defects. However, sequential changes in LVEF did not correlate with short-term prognosis. We conclude that sequential changes in LVEF and RVEF occur frequently following AMI, appear to reflect ventricular loading conditions rather than intrinsic change in myocardial performance, and do not correlate well with short-term prognosis.
本研究的目的是确定首次透壁性急性心肌梗死（AMI）后左、右心室射血分数（LVEF、RVEF）的连续变化以及左心室壁节段运动情况。54例前壁（n = 28）或下壁（n = 26）梗死患者在胸痛发作后48小时内（研究1）、第3至6天（研究2）以及第7至25天（研究3）接受了放射性核素心室造影（RNV）检查。26例前壁心肌梗死患者中有24例（93%）初始LVEF低于0.54，而下壁心肌梗死的26例患者中有13例（50%）初始LVEF低于0.54（p<0.01）。26例下壁心肌梗死患者中有11例（42.3%）初始RVEF低于0.39，而27例前壁心肌梗死患者中有8例（29.6%）初始RVEF低于0.39（p<0.01）。前壁或下壁心肌梗死患者的平均LVEF或平均RVEF总体上无显著的连续变化。从研究1到研究2，24例患者（44%）的LVEF未改变，13例（24%）改善，17例（31%）恶化。从研究1到研究3，15例患者（35%）的LVEF保持不变，17例（39%）改善，11例（26%）恶化。从研究1到研究2，51例患者中有25例（49%）的RVEF未改变，17例（31%）改善，9例（17%）恶化。从研究1到研究3，14例（38%）的RVEF保持不变，18例（48%）改善，5例（14%）恶化。EF的变化往往发生在病程早期，随后变化很小。EF的连续变化无法通过临床或人口统计学变量或梗死部位来预测。LVEF的显著变化通常在左心室壁节段运动无同时改变的情况下发生，提示心室负荷改变而非心肌内在性能改变。LVEF的初始降低与住院死亡率以及充血性心力衰竭和传导缺陷的发生相关。然而，LVEF的连续变化与短期预后无关。我们得出结论，AMI后LVEF和RVEF的连续变化频繁发生，似乎反映了心室负荷情况而非心肌性能的内在变化，且与短期预后相关性不佳。
