[多普勒超声心动图检测急性心肌梗死时二尖瓣关闭不全的临床意义]

[The clinical significance of mitral insufficiency detected by Doppler echocardiography in acute myocardial infarct].

作者信息

Bordalo e Sá A L, González D S, Léon M G, de Sá E P, Pais F, Araújo A, Ferreira R, Ribeiro C

机构信息

UTIC-Arsénio Cordeiro, Hospital de Santa Maria, Faculdade de Medicina, Lisboa, Portugal.

出版信息

Rev Port Cardiol. 1993 Jan;12(1):7, 15-21.

PMID:8517973

Abstract

OBJECTIVE

To assess the clinical significance of mitral regurgitation (MR) diagnosed by pulsed Echo-Doppler in patients with acute myocardial infarction (AMI).

SETTING

Admission in a coronary care unit and a mean follow-up of 12 months.

PATIENTS

Seventy nine patients admitted in a coronary care unit, and 66 patients were followed-up for 12 months (mean).

METHODS

Pulsed Echo-Doppler were performed within three days after admission and the presence of MR was analyzed by apical four and two chamber views.

RESULTS

There were 62 males and 17 females (mean age: 61.4 +/- 10.8 (31-84) years). The location of AMI was: anterior--40, inferior--30, non-Q wave--6, indeterminate--2 and combined--1. Killip classes were: class I--50, class II--20, class III--7 and class IV--2. 17 patients had a previous AMI. The in-hospital mortality was 9 patients (12%) and the post-hospital mortality was 3 patients (4.5%). MR was detected in 24 patients (30%) in whom 14 (58%) had no murmur of MR previously auscultated. MR was considered moderate in 10 patients and mild in the others 14 patients. There were no significant statistical differences in the frequency of MR in relation to AMI location: anterior 57%, inferior 40% (chi 2 = 0.71, NS); to the presence of a previous AMI: 47% vs 26% (chi 2 = 1.93, NS); to age (61 vs 62 years). The patients with MR suffered a more serious degree of heart failure (class III + class IV): 29% vs 4% (chi 2 = 8.41, p < 0.005); higher hospital mortality: 29% vs 4% (chi 2 = 8.41, p < 0.005); and higher one year mortality: 37.5% vs 5.5% (chi 2 = 10.9, p < 0.001).

CONCLUSION

The presence of MR had no relationship with AMI location, the presence of a previous AMI or patients age. The patients with MR had a more serious degree of heart failure, higher hospital and one year mortality. The presence of MR detected by pulsed Echo-Doppler is a sign of bad prognosis although being auscultatory silent in a half of patients.

摘要

目的

评估经脉冲回声多普勒诊断的二尖瓣反流（MR）在急性心肌梗死（AMI）患者中的临床意义。

背景

在冠心病监护病房入院并平均随访12个月。

患者

79例在冠心病监护病房入院的患者，66例患者接受了12个月（平均）的随访。

方法

入院后三天内进行脉冲回声多普勒检查，并通过心尖四腔和两腔视图分析MR的存在情况。

结果

男性62例，女性17例（平均年龄：61.4±10.8（31 - 84）岁）。AMI的部位为：前壁40例，下壁30例，非Q波6例，部位不确定2例，合并情况1例。Killip分级为：I级50例，II级20例，III级7例，IV级2例。17例患者既往有AMI病史。院内死亡9例（12%），院外死亡3例（4.5%）。24例患者（30%）检测到MR，其中14例（58%）之前听诊未闻及MR杂音。10例患者的MR被认为是中度，其余14例为轻度。MR的发生率与AMI部位无关：前壁57%，下壁40%（χ² = 0.71，无显著性差异）；与既往有AMI病史无关：47%对26%（χ² = 1.93，无显著性差异）；与年龄无关（61岁对62岁）。有MR的患者心力衰竭程度更严重（III级 + IV级）：29%对4%（χ² = 8.41，p < 0.005）；院内死亡率更高：29%对4%（χ² = 8.41，p < 0.005）；一年死亡率更高：37.5%对5.5%（χ² = 10.9，p < 0.001）。