Bassan R, Costa Filho R C, Amino J G, Rongel E
Hospital Pró-Cardíaco, Rio de Janeiro.
Arq Bras Cardiol. 1993 Jul;61(1):7-16.
To determine if maintenance of residual blood flow to culprit coronary artery in acute myocardial infarction is important in preserving left ventricular systolic function.
Prospective study of 63 consecutive survivors of acute myocardial infarction in the prethrombolytic era that were submitted to cinecoronary angiography and 30 degrees RAO left ventriculography on the 4th week. Culprit coronary artery patency and collateral circulation were correlated with global and segmental left ventricular contractility.
Spontaneous coronary recanalization correlated significantly with better left ventricular systolic function only in patients with anterior wall myocardial infarction. This relationship was stronger with segmental than with global contractility. Besides, it was seen that absence of recanalization of pre-septal left anterior descending coronary artery occlusion resulted in significantly worse global and segmental left ventricular systolic function than post-septal occlusion, resulting in left ventricular aneurysm in all patients (2/3 of recanalized patients versus 1/3 of post-septal occlusions). Collateral circulation to culprit coronary artery correlated significantly with better global and segmental left ventricular contractility only in patients with inferior wall myocardial infarction.
In acute anterior wall myocardial infarction spontaneous coronary artery recanalization is associated with better global and segmental left ventricular systolic function, specially if the occlusion is of pre-septal localization, while collateral circulation is not related to better contractility. In acute inferior wall myocardial infarction one sees the reverse.
确定急性心肌梗死时罪犯冠状动脉残余血流的维持对保留左心室收缩功能是否重要。
对63例在溶栓前时代连续的急性心肌梗死幸存者进行前瞻性研究，这些患者在第4周接受了冠状动脉造影和30度右前斜位左心室造影。罪犯冠状动脉通畅情况和侧支循环与左心室整体及节段性收缩力相关。
仅在前壁心肌梗死患者中，自发冠状动脉再通与更好的左心室收缩功能显著相关。这种关系在节段性收缩力方面比在整体收缩力方面更强。此外，还发现前间隔左前降支冠状动脉闭塞未再通导致的左心室整体及节段性收缩功能明显比后间隔闭塞更差，所有患者中均出现左心室瘤（再通患者中2/3，后间隔闭塞患者中1/3）。仅在下壁心肌梗死患者中，罪犯冠状动脉的侧支循环与更好的左心室整体及节段性收缩力显著相关。
在急性前壁心肌梗死中，自发冠状动脉再通与更好的左心室整体及节段性收缩功能相关，特别是当闭塞位于前间隔时，而侧支循环与更好的收缩力无关。在急性下壁心肌梗死中情况则相反。
