左室造影对急性心肌梗死后左室重构发生的评价

目的 :探讨左室造影对急性心肌梗死 (AMI)后左室重构发生的评价及其临床意义。方法 :用左室造影投影系统计算出心肌梗死 (MI)急性期及恢复期左室容积指标 ,根据左室容积指标将患者分为重构组和非重构组 (均为 2 0例 ) ;用漂浮导管测定血流动力学指标 ;用99m 锝心血池扫描测定左室射血分数 (LVEF) ;用2 0 1铊心肌血流扫描测定梗死的面积积分 (ES)和重症度积分(SS)。结果 :重构组恢复期左室舒张末期及收缩末期容积均显著高于非重构组 (P <0 .0 1) ,亦显著高于该组急性期左室容积 (P <0 .0 1)。重构组急性期肌酸磷酸激酶峰值、急性期及恢复期肺小动脉嵌压、恢复期左室舒张末压力以及恢复期ES和SS均显著高于非重构组 ,而LVEF显著低于非重构组。重构组恢复期左室收缩末期容积及舒张末期容积与LVEF之间存在有意义的相关关系 (r =- 0 .72 ,P <0 .0 1;r =- 0 .6 7,P <0 .0 1)。结论 :AMI后进行左室造影能较准确地评价左室重构的发生及严重程度。发生左室重构的患者其心肌坏死量较大 ,且其恢复期左室功能显著降低。恢复期左室功能与左室容积指标之间存在密切相关。

Evaluation of left ventricular remodeling after acute myocardial infarction by left ventriculography

Objective: To evaluate the left ventricular remodeling after acute myocardial infarction by left ventriculography. Method:Left ventriculography (LVG) was performed in both emergency and convalescent phase. Left ventricular end- systolic volume index (LVESVI) and left ventricular end-diastolic volume index (LVEDVI) were calculated by area-length method from the film of LVG. Hemodynamic parameters were measured by Swan-ganz catheter, left ventricular ejection fraction(LVEF) were measured by 99m Tc gated cardiac blood scintigraphy. The quantitative evaluation of infarction, extent score and severity score, were measured by 201Tl SPECT. Result: In remodeling group, both LVESVI and LVEDVI in convalescent phase were significantly higher than those in non-remodeling group, and were also higher than those in acute phase. PCWP in both acute and convalescent phase, the peak value of CPK, the extent score and severity score of infarction and left ventricular end diastolic pressure were significant higher in remodeling group, Left ventricular ejection fraction were significantly lower in this group, and were correlated significantly with LVESVI and LVEDVI in convalescent phase.Conclusion: Left ventriculography are useful in evaluation of left ventricular remodeling after acute myocardial infarction . In remodeling group, the infarct sizes were larger and LVEF were lower than those in non-remodeling group. LVEF in convalescent phase were correlated closely with the left ventricular volume in this group.