Munclinger M J, Dougeni-Christacou V, Furniss S S, Bazuaye E A, Mould H, Gibson G J, Campbell R W
Academic Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK.
Int J Cardiol. 1994 Jul;45(3):177-82. doi: 10.1016/0167-5273(94)90163-5.
Factors influencing the incidence of right ventricular infarction among patients with acute inferior myocardial infarction have not yet been fully established. Chronic obstructive airways disease and right ventricular hypertrophy were suggested as possible predisposing factors but no definite evidence was shown. This study analyses the frequency of chronic obstructive airway disease and of Doppler assessed pulmonary hypertension among patients with acute inferior myocardial infarction with or without right ventricular infarction.
Sixty consecutive patients with acute inferior myocardial infarction were prospectively enrolled into the study.
Standard 12-lead ECG with right precordial leads (V3-6R) were recorded on admission to the Coronary Care Unit and on days 2 and 3. Doppler echocardiography was performed within 48 h after the onset of myocardial infarction and repeated 6 weeks later together with a pulmonary function test. Routine biochemical and clinical data were collected.
Right ventricular infarction occurred in 35% of patients with acute inferior myocardial infarction. No differences in respiratory indices of chronic obstructive airways disease or in Doppler echocardiography parameters of pulmonary hypertension were revealed among patients with and without right ventricular infarction. Peak total creatine kinase level and creatine kinase myocardial isoenzyme levels were higher in patients with right ventricular infarction than in those without (2925 +/- 1321 vs. 1682 +/- 1216 U/l; P < 0.001 and 207 +/- 108 vs. 127 +/- 102 U/l; P < 0.05, respectively).
In the course of acute inferior myocardial infarction, the frequencies of chronic obstructive airways disease and/or pulmonary hypertension were not higher among patients with right ventricular infarction than among those without right ventricular infarction. Thus, history of chronic obstructive airways disease and/or pulmonary hypertension do not necessitate specific precautions in respect of right ventricular infarction.
急性下壁心肌梗死患者右心室梗死发生率的影响因素尚未完全明确。慢性阻塞性气道疾病和右心室肥厚被认为是可能的易感因素，但尚无确凿证据。本研究分析了合并或不合并右心室梗死的急性下壁心肌梗死患者中慢性阻塞性气道疾病的发生率以及经多普勒评估的肺动脉高压情况。
连续60例急性下壁心肌梗死患者前瞻性纳入本研究。
入院时、入院后第2天和第3天记录标准12导联心电图及右胸前导联（V3 - 6R）。在心肌梗死发作后48小时内进行多普勒超声心动图检查，并在6周后重复检查，同时进行肺功能测试。收集常规生化和临床数据。
急性下壁心肌梗死患者中35%发生右心室梗死。合并和未合并右心室梗死的患者在慢性阻塞性气道疾病的呼吸指标或肺动脉高压的多普勒超声心动图参数方面均未显示出差异。右心室梗死患者的总肌酸激酶峰值水平和肌酸激酶心肌同工酶水平高于无右心室梗死的患者（分别为2925±1321 vs. 1682±1216 U/L；P < 0.001和207±108 vs. 127±102 U/L；P < 0.05）。
在急性下壁心肌梗死过程中，合并右心室梗死的患者慢性阻塞性气道疾病和/或肺动脉高压的发生率并不高于未合并右心室梗死的患者。因此，慢性阻塞性气道疾病和/或肺动脉高压病史并不需要针对右心室梗死采取特殊预防措施。
