Kinn J W, Ajluni S C, Samyn J G, Bates E R, Grines C L, O'Neill W
Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
J Am Coll Cardiol. 1995 Nov 1;26(5):1230-4. doi: 10.1016/0735-1097(95)00311-8.
This study sought to determine the effects of reperfusion on hemodynamic status and hospital course in patients with right ventricular infarction.
In contrast to the relatively low risk associated with acute inferior myocardial infarction, right ventricular infarction is associated with higher in-hospital morbidity and mortality. However, the potential benefits of reperfusion in patients with right ventricular infarction are unknown. Consequently, this study evaluated the potential benefits of primary angioplasty in patients with right ventricular infarction.
Of 141 consecutive patients admitted to the hospital for inferior myocardial infarction, 27 were identified as having right ventricular involvement by electrocardiographic and hemodynamic criteria. Seventeen patients achieved patency of the infarct-related right coronary artery by primary coronary angioplasty within 24 h of hospital admission, but 10 patients did not. All patients had invasive hemodynamic monitoring at the time of hospital admission, and subsequent serial hemodynamic status and clinical events were recorded.
Patients with successful reperfusion demonstrated improved right atrial pressure, pulmonary capillary wedge pressure and right atrial/pulmonary capillary wedge pressure ratio as early as 8 h after reperfusion, whereas patients without reperfusion had no hemodynamic improvement over 24 h. Right atrial pressure demonstrated the greatest 8-h improvement after successful reperfusion (15.4 +/- 0.8 to 8.4 +/- 0.8 mm Hg [mean +/- SD], p < 0.05) but was unchanged without reperfusion (13.7 +/- 0.9 to 13.9 +/- 0.8 mm Hg, p = NS). Additionally, persistently elevated right atrial pressure was associated with increased mortality.
Reperfusion in the setting of right ventricular infarction leads to rapid hemodynamic improvement and may result in improved survival.
本研究旨在确定再灌注对右心室梗死患者血流动力学状态及住院病程的影响。
与急性下壁心肌梗死相对较低的风险不同，右心室梗死与较高的院内发病率和死亡率相关。然而，右心室梗死患者再灌注的潜在益处尚不清楚。因此，本研究评估了直接血管成形术对右心室梗死患者的潜在益处。
在连续收治的141例下壁心肌梗死患者中，根据心电图和血流动力学标准，确定27例患者合并右心室受累。17例患者在入院后24小时内通过直接冠状动脉血管成形术使梗死相关右冠状动脉开通，但10例患者未开通。所有患者入院时均进行了有创血流动力学监测，并记录随后的系列血流动力学状态和临床事件。
成功再灌注的患者在再灌注后8小时即显示右心房压力、肺毛细血管楔压及右心房/肺毛细血管楔压比值改善，而未再灌注的患者在24小时内血流动力学无改善。成功再灌注后右心房压力在8小时改善最为显著（从15.4±0.8降至8.4±0.8 mmHg[均值±标准差]，p<0.05），但未再灌注时无变化（从13.7±0.9升至13.9±0.8 mmHg，p=无统计学意义）。此外，持续升高的右心房压力与死亡率增加相关。
右心室梗死时进行再灌注可导致血流动力学迅速改善，并可能改善生存率。
