Inoue T, Morooka S, Hayashi T, Takayanagi K, Sakai Y, Fujito T, Takabatake Y
Department of Cardiology, Koshigaya Hospital, Dokkyo University School of Medicine, Saitama, Japan.
Angiology. 1993 Aug;44(8):593-8. doi: 10.1177/000331979304400801.
To determine the factors of left ventricular aneurysm formation in acute myocardial infarction, the authors studied the distribution of coronary artery lesions and the left ventricular wall motion of 43 patients with anterior myocardial infarction. Of 15 patients with aneurysm, 9 (60%) showed a single-vessel disease with severe stenosis of the proximal left anterior descending artery. Of 9 patients with triple-vessel disease, 8 (89%) had no aneurysm. In patients with the aneurysm, the Gensini score of the culprit lesion was significantly higher (p < 0.05) and the score except for the culprit lesion was less (chi 2 = 5.7, p < 0.05). In 23 patients with single-vessel disease, the collateral score was significantly less (p < 0.05) in patients with the aneurysm. The systolic wall motion on the ventriculogram appeared more impaired in the anterior infarct area but well maintained in the posterior noninfarct area in patients with the aneurysm. In conclusion, the important factors of left ventricular aneurysm formation were as follows: (1) A culprit lesion of the myocardial infarction was severe, but other coronary artery lesions were mild. (2) Collateral vessels were poor. (3) The left ventricular wall motion of the infarct area was impaired, but that of the noninfarct area was relatively good.
为了确定急性心肌梗死患者左心室室壁瘤形成的相关因素，作者研究了43例前壁心肌梗死患者的冠状动脉病变分布及左心室壁运动情况。在15例室壁瘤患者中，9例（60%）表现为单支血管病变，即左前降支近端严重狭窄。在9例三支血管病变患者中，8例（89%）未发生室壁瘤。有室壁瘤的患者中，罪犯病变的Gensini评分显著更高（p<0.05），而除罪犯病变外的评分更低（χ2=5.7，p<0.05）。在23例单支血管病变患者中，有室壁瘤的患者侧支循环评分显著更低（p<0.05）。有室壁瘤的患者心室造影显示，前壁梗死区域的收缩期壁运动受损更严重，而后壁非梗死区域的运动保持良好。总之，左心室室壁瘤形成的重要因素如下：（1）心肌梗死的罪犯病变严重，但其他冠状动脉病变较轻。（2）侧支血管较差。（3）梗死区域的左心室壁运动受损，但非梗死区域的运动相对良好。
