Penco M, Dagianti A, Rosanio S, Romano S, Dagianti A
Dipartimento di Medicina Interna e Sanità Pubblica, Università degli Studi, L'Aquila.
Cardiologia. 1996 Aug;41(8):751-8.
The aim of this study was to evaluate, in a large series of patients (420 males, 104 females, mean age 59 +/- 9.4 years) with acute myocardial infarction (AMI), the role of electrocardiography and two-dimensional echocardiography in identifying the site and the extension of the necrotic area, with regard to the treatment (thrombolysis or not) and the extent of coronary artery disease. Our results have shown a good correlation between ECG and echo in evaluating the infarct size, with a larger extension in echo examinations. Regarding the infarct site, a good correlation was found in anterior AMI, but not in inferior AMI. Thrombolytic therapy does not seem to introduce significant variations in this regard. Furthermore, the results of coronary angiography have shown that two-dimensional echocardiography allows us to identify the infarct-related coronary artery in a larger number of patients (90%) compared to ECG (80%). On the contrary, the two methods are similar in evaluating the extent of coronary artery disease, with correct identification of only one third of patients, the majority of them with single-vessel disease. Finally, we observed that the presence of abnormal apical wall motion is frequent (47%), in the majority of cases associated with anterior wall motion abnormalities, while in 5% of the cases the apex alone is involved. This finding suggests an analogy between these "apex infarctions" and the non Q wave infarctions, in which necrosis is present only in a little zone of a larger area at risk.
本研究旨在评估在一大组急性心肌梗死（AMI）患者（420例男性，104例女性，平均年龄59±9.4岁）中，心电图和二维超声心动图在确定坏死区域的部位和范围方面的作用，涉及治疗（是否溶栓）及冠状动脉疾病的程度。我们的结果显示，在评估梗死面积方面，心电图和超声心动图之间存在良好的相关性，超声心动图检查显示的梗死范围更大。关于梗死部位，在前壁AMI中发现了良好的相关性，但在下壁AMI中则不然。溶栓治疗在这方面似乎并未引起显著差异。此外，冠状动脉造影结果表明，与心电图（80%）相比，二维超声心动图能够在更多患者（90%）中识别出梗死相关冠状动脉。相反，在评估冠状动脉疾病的程度方面，这两种方法相似，仅能正确识别三分之一的患者，其中大多数为单支血管病变。最后，我们观察到心尖壁运动异常很常见（47%），大多数情况下与前壁运动异常相关，而在5%的病例中仅心尖受累。这一发现表明这些“心尖梗死”与非Q波梗死之间存在相似性，即在较大的危险区域中仅一小部分区域存在坏死。
