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目的为缺血性心肌病(ICM)的早期诊断及治疗决策提供依据。方法对88例拟诊为扩张性心肌病(DCM)的患者经常规药物治疗控制心衰,后均做选择性冠状动脉造影(CAG);回顾性分析诊断为ICM患者的临床特点,治疗方法及疗效,并做前瞻性研究。结果88例拟诊为DCM患者的CAG结果显示:69例(78.4%)冠状动脉狭窄(>75%)或弥漫性狭窄或和闭塞,结合病史将此69例患者诊断为ICM。有典型心绞痛、心肌梗死46例(66.7%)。临床表现主要为心慌、胸闷及气短,其中左心衰60例(86.9%),全心衰9例(13.1%);心电图ST段改变伴定位性Q波47例(68.1%);心脏超声左心室增大58例(84.1%),心律失常44例(63.8%);单支病变7例(10.2%),多支病变62例(89.8%),表现为前降支(LAD)病变64例(92.8%);52例(75.4%)行PC I,PC I to LAD 40例(90.9%)。均好转出院。结论ICM临床上酷似DCM;CAG是早期诊断ICM的依据;LAD病变是引起ICM的主要“罪犯”血管;对ICM患者应早期行PC I。
Objective To provide basis for early diagnosis and treatment decision of ischemic cardiomyopathy (ICM). Methods Eighty-eight patients diagnosed as dilated cardiomyopathy (DCM) underwent routine medical therapy to control heart failure and were followed by selective coronary angiography (CAG). The clinical features, treatment and diagnosis of ICM patients were retrospectively analyzed Efficacy, and do prospective studies. RESULTS: The CAG results of 88 patients diagnosed as DCM showed 69 patients (78.4%) with coronary stenosis (> 75%) or diffuse stenosis or occlusion, and the 69 patients were diagnosed as ICM according to the history. A typical angina, myocardial infarction in 46 cases (66.7%). The main clinical manifestations were palpitation, chest tightness and shortness of breath. Among them, 60 cases (86.9%) had left heart failure and 9 cases (13.1%) had heart failure; electrocardiographic ST segment changes with 47 cases (68.1% 58 cases (84.1%) had ventricular enlargement, 44 cases (63.8%) had arrhythmia, 7 cases (10.2%) had single vessel disease and 62 cases (89.8%) had multiple vessel disease. (92.8%). PC (52 cases) (75.4%) had PC I and PC I to LAD in 40 cases (90.9%). Are better discharged. Conclusion ICM is clinically similar to DCM. CAG is the basis for early diagnosis of ICM. LAD lesion is the predominant “criminal” blood vessel causing ICM. PCI should be performed in ICM patients.