论文部分内容阅读
目的:评价急性前壁ST段抬高性心肌梗死直接经皮冠状动脉成形术(PCI)患者的右心室收缩和舒张功能变化。方法:分析46例急性前壁ST段抬高性心肌梗死患者[前降支近端完全闭塞者24例(前降支近端闭塞组),前降支远端急性闭塞者22例(前降支远端闭塞组)]直接PCI和35例冠状动脉造影“正常”患者(对照组)的临床、冠状动脉造影和心电图资料。采用二维心脏超声分别测定入选患者的右心室舒张末期容积(RVEDV),右心室收缩末期容积(RVESV),右心室射血分数(RVEF),平均肺动脉压(MPAP),左心室舒张末期容积(LVEDV),左心室收缩末期容积(LVESV),左心室射血分数(LVEF)和心脏指数(CI)。结果:与对照组相比,前降支远端闭塞组的平均肺动脉压无显著性差异(P>0.05),而右心室舒张末期容积和收缩末期容积增大,右心室射血分数降低;左心室舒张末期容积和收缩末期容积增加,左心室射血分数、心脏指数减低(P均<0.01)。与前降支远端闭塞组比较,前降支近端闭塞组的左心室舒张末期容积和收缩末期容积增加(P<0.01),心脏指数和左心室射血分数减少(P<0.01),右心室舒张末期容积收缩末期容积和平均肺动脉压增加(P<0.05～0.01),右心室射血分数降低(P<0.01)。多元线性回归分析表明前降支近端闭塞与右心室射血分数降低(R2=0.38,P<0.01)、右心室舒张末期容积增加(R2=0.410,P<0.01)有较好的相关性。2周后,前降支近端和远端闭塞组的右心室舒张末期容积、右心室收缩末期容积、平均肺动脉压和右心室射血分数无明显差异,而前降支近端闭塞患者的左心室舒张末期容积和收缩末期容积增大,左心室射血分数和心脏指数较低(P均<0.01)。结论:提示前降支近端闭塞可能伴右心室前壁部分心肌梗死导致右心室收缩和舒张功能障碍。
PURPOSE: To evaluate the changes of right ventricular systolic and diastolic function in patients with acute anterior wall ST-segment elevation myocardial infarction undergoing percutaneous transluminal coronary angioplasty (PCI). Methods: Forty-six patients with ST-segment elevation myocardial infarction in the anterior wall of the anterior wall (24 patients with proximal complete anterior descending artery (proximal anterior descending artery occlusion) and 22 patients with acute distal anterior descending artery Branch and distal occlusion group)] clinical, coronary angiography, and electrocardiogram data from direct PCI and 35 patients with coronary angiography “normal ” (control group). The left ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume (RVESV), right ventricular ejection fraction (RVEF), mean pulmonary arterial pressure (MPAP) and left ventricular end-diastolic volume LVEDV, LVESV, LVEF and CI. Results Compared with the control group, the mean pulmonary artery pressure in the distal left anterior descending artery occlusion group had no significant difference (P> 0.05), while the right ventricular end-diastolic volume and the end-systolic volume increased while the right ventricular ejection fraction decreased Ventricular end diastolic volume and end-systolic volume increased, left ventricular ejection fraction, cardiac index decreased (P all <0.01). Compared with the distal occlusion group, the volume of left ventricular end-diastolic volume and the end-systolic volume in the proximal anterior descending artery occlusion group increased (P <0.01), the cardiac index and left ventricular ejection fraction decreased (P <0.01) Ventricular end-diastolic volume and mean pulmonary artery pressure (P <0.05 ~ 0.01), right ventricular ejection fraction decreased (P <0.01). Multivariate linear regression analysis showed that there was a good correlation between proximal occlusion of the left anterior descending artery and right ventricular ejection fraction (R2 = 0.38, P <0.01) and right ventricular end-diastolic volume (R2 = 0.410, P <0.01). After 2 weeks, there was no significant difference in right ventricular end-diastolic volume, right ventricular end-systolic volume, mean pulmonary artery pressure and right ventricular ejection fraction in proximal and distal anterior descending artery occlusion group Ventricular end-diastolic volume and end-systolic volume increased, left ventricular ejection fraction and cardiac index were lower (P <0.01). Conclusion: It is suggested that the proximal occlusion of the anterior descending artery may have some myocardial infarction in the anterior wall of the right ventricle leading to right ventricular systolic and diastolic dysfunction.