Sugiura T, Iwasaka T, Tarumi N, Takehana K, Nagahama Y, Inada M
Second Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
Am J Cardiol. 1994 May 1;73(12):862-4. doi: 10.1016/0002-9149(94)90810-9.
To assess the clinical significance of pericardial effusion in Q-wave inferior wall acute myocardial infarction, 185 consecutive patients were examined by means of electrocardiogram, echocardiogram and hemodynamic monitoring. A pericardial effusion was present in 44 patients and was absent in 141 patients. Electrocardiographic right ventricular infarction (> or = 1 mm of ST-segment elevation and Q wave in V4R) was detected in 54 patients, with 20 patients having pericardial effusion. Patients with pericardial effusion had significantly more left ventricular segments with advanced asynergy, lower cardiac output, higher pulmonary artery wedge pressure and higher incidence of right ventricular infarction than those without pericardial effusion. There were 17 in-hospital deaths. Although there was no significant difference in the mortality rate between patients with and without right ventricular infarction, a significantly higher hospital mortality rate was observed in patients with pericardial effusion compared to those without it (23 vs 5%). Pericardial effusion was selected with age and pulmonary artery wedge pressure as important variables associated with hospital mortality by the discriminant analysis. Patients who developed pericardial effusion, regardless of right ventricular infarction, had more extensive myocardial damage, and hence, pericardial effusion was one of the predictors of increased hospital mortality.
为评估Q波下壁急性心肌梗死时心包积液的临床意义，对185例连续患者进行了心电图、超声心动图及血流动力学监测检查。44例患者存在心包积液，141例患者无心包积液。54例患者检测到心电图右心室梗死（V4R导联ST段抬高≥1mm且有Q波），其中20例有心包积液。有心包积液的患者与无心包积液的患者相比，左心室节段运动失调更严重，心输出量更低，肺动脉楔压更高，右心室梗死发生率更高。住院死亡17例。虽然右心室梗死患者与无右心室梗死患者的死亡率无显著差异，但有心包积液的患者与无心包积液的患者相比，住院死亡率显著更高（23%对5%）。通过判别分析，选择年龄和肺动脉楔压作为与住院死亡率相关的重要变量的心包积液。发生心包积液的患者，无论有无右心室梗死，心肌损伤都更广泛，因此，心包积液是住院死亡率增加的预测因素之一。
