影响急性心肌梗死左心室重构及功能的其他因素

目的观察冠心病危险因素和冠状动脉病变累及数对急性心肌梗死患者左室重构和功能的影响。方法180例急性心肌梗死患者经冠状动脉造影对病变血管进行定量。应用美国ACUSON公司生产128XP/10电脑声像仪测定心脏各项指标。分析血压、血脂、吸烟、血尿酸等冠心病危险因素和冠状动脉病变支数对急性心肌梗死左室射血分数的影响,以及长期高血压对左室重构和功能的影响。结果急性心肌梗死时的收缩压和病变血管数与LVEF值呈明显负相关,即病变血管累及越多,左室EF值越低;心肌梗死时收缩压越高,LVEF值越低(P<0.05)。先前有高血压病的心肌梗死患者LVEF值明显降低,左室舒张末期内径和左室质量显著高于无高血压病组患者(P<0.001)。其他冠心病危险因素舒张压、血脂、吸烟、血尿酸与左室EF值变化无明显相关性。结论心肌梗死时收缩压和冠状动脉多支病变影响了急性心肌梗死患者LVEF值,使LVEF值降低;高血压病对急性心肌梗死左室重构和心脏功能有明显的影响。长期血压升高是造成左室重构和收缩功能减弱的主要原因。高血压的控制和冠心病的一级预防在保护心肌重构和功能方面起重要作用。

Effect of uncommon risk factors on cardiac remodeling and dysfunction in patients with acute myocardial infarction

Objective To evaluate the effect of risk factors and the number of coronary branch with stenosis on leftventricular remodeling and systolic function in patients with acute myocardial infarction (AMI). Methods According totypical clinical symptom, cTnT, cardiac enzyme and ECG, 180 patients with AMI were involved in this study. The num-ber of coronary branch with stenosis was quantified by coronary angiography. Cardiac parameters including end- dias-tolic interventricular septum thickness (IVSd), end- diastolic left ventricular internal diameter (LVd), left ventricular mass(LM) and left ventricular ejection fraction (LVEF) were measured by echocardiography. The effluence of t the number ofcoronary branch with stenosis, blood pressure, blood lipids, and glucose on LVEF and LVd was analyzed. Results Thenumber of coronary branch with stenosis and systolic blood pressure after AMI were related negatively to LVEF, whilethere were no significant relationship between other facts and LVEF. LVEF was significantly decreased, while LVd andLM were remarkably increased in patients with hypertension before AMI, compared with patients without hypertension(P<0.001). Conclusion Multiple vessel stenosis and systolic blood pressure mainly affected LVEF after AMI. An-tecedent hypertension might be one of the reasons leading to cardiac remodeling and dysfunction. Therefore primary pre-vention of coronary heart disease is important for protecting heart from remodeling and dysfunction.