心肌梗死后远隔区域的长期功能：非梗死相关动脉中显著冠状动脉狭窄的重要性。

Long-term function in the remote region after myocardial infarction: importance of significant coronary stenoses in the non-infarct-related artery.

作者信息

de Albuquerque C P, Kalil-Filho R, Gerstenblith G, Nakano O, Barbosa V, Bellotti G, Pileggi F, Tranchesi B

机构信息

Heart Institute, University of São Paulo, Brazil.

出版信息

Br Heart J. 1994 Mar;71(3):249-53. doi: 10.1136/hrt.71.3.249.

DOI:10.1136/hrt.71.3.249

PMID:8142194

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC483662/

Abstract

BACKGROUND

Left ventricular (LV) function is the most important determinant of outcome after a myocardial infarction. Global LV function after a myocardial infarction is affected not only by wall motion in the infarct zone but also by regional function in the contralateral territory. It was hypothesised that the presence of significant stenoses in coronary arteries supplying the contralateral territory might influence the ability of this region to compensate for damaged myocardium after a myocardial infarction.

METHODS AND RESULTS

79 patients treated with thrombolysis for acute myocardial infarction had coronary and ventricular angiograms within 24 h and at a mean follow up of 12 months after myocardial infarction. Wall motion in the contralateral territory was analysed and scored by the centre line method and the change over time was correlated with the presence or absence of significant (> 70%) diameter stenoses in the non-infarct-related artery. Mean (SD) contralateral territory motion worsened, from 0.74 (1.78) to -1.55 (2.06) SD chord (p < 0.001) in 40 patients with stenoses, whereas contralateral territory motion improved from -0.02 (2.4) to 0.63 (2.21) SD chord (p < 0.05) in the 39 patients without coronary stenoses. The same pattern was present whether or not the infarct artery was patent. The global left ventricular ejection fraction at 12 months was also related to contralateral territory motion (r = 0.71, p < 0.001) and to the presence of coronary stenoses (54 (15)% in those with coronary stenoses and 62 (16)% in those without, p < 0.05).

CONCLUSION

The results demonstrate that significant stenoses in arteries supplying the non-infarct territory adversely affect global and regional left ventricular function after a transmural infarction. Non-infarct artery anatomy should be considered in intervention strategies to improve left ventricular function after acute myocardial infarction.

摘要

背景

左心室（LV）功能是心肌梗死后预后的最重要决定因素。心肌梗死后的整体左心室功能不仅受梗死区域室壁运动的影响，还受对侧区域功能的影响。据推测，供应对侧区域的冠状动脉存在明显狭窄可能会影响该区域在心肌梗死后补偿受损心肌的能力。

方法与结果

79例接受急性心肌梗死溶栓治疗的患者在24小时内及心肌梗死后平均12个月时进行了冠状动脉造影和心室造影。采用中心线法分析并评分对侧区域的室壁运动，其随时间的变化与非梗死相关动脉中是否存在明显（>70%）直径狭窄相关。40例有狭窄患者的对侧区域平均（标准差）运动恶化，从0.74（1.78）标准差弦变为-1.55（2.06）标准差弦（p<0.001），而39例无冠状动脉狭窄患者的对侧区域运动从-0.02（2.4）标准差弦改善至0.63（2.21）标准差弦（p<0.05）。无论梗死动脉是否通畅，均呈现相同模式。12个月时的整体左心室射血分数也与对侧区域运动（r=0.71，p<0.001）及冠状动脉狭窄的存在情况相关（有冠状动脉狭窄者为54（15）%，无狭窄者为62（16）%，p<0.05）。