Hirose K, Reed J E, Rumberger J A
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Am Coll Cardiol. 1995 Aug;26(2):394-400. doi: 10.1016/0735-1097(95)80012-6.
This study investigated serial changes in regional right ventricular free wall and interventricular septal wall lengths during the first 4 to 5 years after an index anterior wall myocardial infarction.
We previously demonstrated that remodeling after anterior wall myocardial infarction was a biventricular process; however, regional changes in biventricular topology were not investigated.
Serial electron beam computed tomographic scanning was performed in 19 patients at five times (hospital discharge and at 6 weeks, 6 months, 1 year and 4 to 5 years) after an index anterior wall myocardial infarction, and global and regional right ventricular free wall and interventricular septal wall lengths were quantified.
At a mean (+/- SD) of 1,642 +/- 171 days (4 to 5 years) after infarction, global end-diastolic and end-systolic right ventricular free wall and interventricular septal wall lengths increased in parallel by 13% to 23% as global left and right ventricular volumes increased 22% to 29% from hospital discharge to 4 to 5 years after infarction. When global right ventricular free wall was compared with interventricular septal wall lengths, percent increases at end-diastole and end-systole were not statistically different at any time during the study period. Distinct regional changes in both right ventricular free wall and interventricular septal wall lengths after infarction were most dramatic during the first 6 weeks and primarily confined to the most apical levels. However, further and significant increases in both were observed by 4 to 5 years after infarction.
Changes in both right ventricular free wall and interventricular septal wall lengths were apparent during the 4 to 5 years after the index anterior wall infarction, and the combination of both contributed to global increases in right and left ventricular chamber volumes. Regional changes in both right ventricular free wall and interventricular septal wall lengths were almost exclusively confined to their respective apices and progressed generally in parallel; however, the cause-and-effect relation remains speculative at the present time.
本研究调查了首次前壁心肌梗死后最初4至5年内右心室游离壁和室间隔壁长度的系列变化。
我们之前证明前壁心肌梗死后的重塑是双心室过程；然而，双心室拓扑结构的区域变化未被研究。
对19例患者在首次前壁心肌梗死后进行了5次系列电子束计算机断层扫描（出院时、6周、6个月、1年以及4至5年），并对整体及区域右心室游离壁和室间隔壁长度进行了量化。
在梗死平均（±标准差）1642±171天（4至5年）后，随着整体左、右心室容积从出院时到梗死后4至5年增加22%至29%，整体舒张末期和收缩末期右心室游离壁和室间隔壁长度平行增加13%至23%。当比较整体右心室游离壁和室间隔壁长度时，在研究期间的任何时间，舒张末期和收缩末期的增加百分比均无统计学差异。梗死后右心室游离壁和室间隔壁长度的明显区域变化在最初6周内最为显著，且主要局限于最心尖水平。然而，在梗死后4至5年观察到两者进一步且显著增加。
在首次前壁梗死后4至5年内，右心室游离壁和室间隔壁长度均有明显变化，两者共同导致左、右心室腔容积整体增加。右心室游离壁和室间隔壁长度的区域变化几乎完全局限于各自的心尖，且总体上平行进展；然而，目前因果关系仍具有推测性。
