Temporelli P L, Corrå U, Marcassa C, Galli M, Imparato A, Giannuzzi P
Fondazione Salvatore Maugeri, IRCCS, Divisione di Cardiologia, Centro Medico di Riabilitazione, Veruno.
G Ital Cardiol. 1996 Jul;26(7):729-37.
The effects of acute and recurrent ischemia on ventricular function are well documented. However, the role of residual exertional ischemia in the remodelling process after infarction has not yet been established. In this study, we investigated whether exercise-induced myocardial ischemia influences left ventricular remodelling in patients with recent myocardial infarction and preserved left ventricular function and volumes.
Sixty-four patients with a first anterior Q wave myocardial infarction were studied at 5 weeks by rest echocardiography and exercise scintigraphy; the echocardiographic examination at rest was repeated 6 months later. Based on the presence and extent of reversible perfusion defects on exercise scintigraphy, patients were classified as having no exertional ischemia (group 1, n = 13 [20%]), mild to moderate ischemia (group 2, n = 32 [50%]) and severe exertional ischemia (group 3, n = 19 [30%]).
At 5 weeks after infarction left ventricular volumes, ejection fraction, percent wall motion abnormalities and regional dilatation were similar in the three groups. After 6 months, end-diastolic and end-systolic volumes and regional dilatation did not change in patients in all groups, while ejection fraction and percent wall motion abnormalities showed a slight but significant (p < 0.01) improvement in all groups.
Exercise-induced myocardial ischemia, either mild or severe, does not affect ventricular remodelling and function after myocardial infarction in patients with preserved ejection fraction.
急性和反复缺血对心室功能的影响已得到充分记录。然而，残余运动性缺血在心肌梗死后重塑过程中的作用尚未明确。在本研究中，我们调查了运动诱发的心肌缺血是否会影响近期心肌梗死且左心室功能和容积保留的患者的左心室重塑。
通过静息超声心动图和运动闪烁显像对64例首次前壁Q波心肌梗死患者在5周时进行研究；6个月后重复静息超声心动图检查。根据运动闪烁显像上可逆灌注缺损的存在和范围，将患者分为无运动性缺血组（第1组，n = 13 [20%]）、轻度至中度缺血组（第2组，n = 32 [50%]）和重度运动性缺血组（第3组，n = 19 [30%]）。
梗死后5周，三组患者的左心室容积、射血分数、室壁运动异常百分比和局部扩张情况相似。6个月后，所有组患者的舒张末期和收缩末期容积以及局部扩张均未改变，而所有组的射血分数和室壁运动异常百分比均有轻微但显著（p < 0.01）的改善。
对于射血分数保留的患者，轻度或重度运动诱发的心肌缺血均不影响心肌梗死后的心室重塑和功能。
