Neurohormonal effects of early treatment with enalapril after acute myocardial infarction and the impact on left ventricular remodelling

Plasma neurohormones were sequentially analysed in 98 patientswith acute myocardial infarction randomized to treatment withenalapril or placebo for 4–6 months. Plasma angiotensinconverting enzyme activity was rapidly suppressed by enalapril,but unaffected by placebo (P = 0.0001). No significant differenceswere found in the plasma levels of angiotensin II, aldosterone,atrial natriuretic peptide, noradrenaline, adrenaline or dopaminebetween the two treatment groups. Among patients with infarctsize above median, plasma angiotensin II increased during head-uptilt at one month in the placebo group, but not in the enalaprilgroup. Left ventricular end-diastolic volume (LVEDV) and leftventricular endsystolic volume (LVESV) were evaluated by echocardiographyin 28 patients (placebo 15, enalapril 13) and changes in leftventricular volumes between baseline and 4–6 months werecalculated. Only in the placebo group was a positive correlationfound between plasma levels of noradrenaline at day 5–7and the subsequent increase in LVEDV (r = 0.78, P = 0.005) andLVESV (r = 0.75, P = 0.008). The same trend was found for angiotensinII, adrenaline and dopamine levels at days 5–7 and thesubsequent increase in left ventricular volumes. In the placebogroup a negative correlation was found between plasma aldosteroneat days 5–7 and the subsequent increase in left ventricularejection fraction (r = –0.77, P = 0.006) during the studyperiod. Although circulating neurohormones were not significantlyinfluenced by enalapril treatment, it is concluded that enalaprilmay influence the relationship found between sustained neurohormonalactivation and left ventricular remodelling after acute myocardialinfarction.     

急性心肌梗死后左室重构临床研究

目的　探讨溶栓治疗对急性心肌梗死后左室结构和功能的影响。方法　对 36例首发急性心肌梗死患者于梗死后 4周和 12周进行超声心动图观察。分别测定左室舒张末期容积指数 (LVEDVI)、左室收缩末期容积指数 (LVESVI)、射血分数 (EF) ,作为反映左室结构和功能变化的指标。结果　急性心肌梗死后LVEDVI、LVESVI均明显增高 (分别为P <0 0 1,P <0 0 5 )。 4周和 12周检查发现 ,溶栓组LVEDVI、LVESVI无明显差异 (分别P>0 0 5 ,P >0 0 5 ) ,EF值明显增大 (P <0 0 5 ) ;未溶栓组LVEDVI、LVESVI明显增大 (分别为P <0 0 5 ,P <0 0 5 ) ,EF值无明显变化 (P >0 0 5 ) ;对 4周和 12周的检查结果作组间比较发现 ,溶栓组LVEDVI、LVESVI均小于未溶栓组 (P <0 0 5 ) ,EF值溶栓组高于未溶栓组 (P <0 0 5 )。结论　溶栓治疗能有效地抑制急性心肌梗死后左室重构 ,改善心功能。     

糖尿病合并急性心肌梗塞病人心功能的临床评价

对６７例急性心肌梗塞（ＡＭＩ）合并Ⅱ糖尿病人（ＤＭ－ＡＭＩ组），和按其一般情况及梗塞部位配对的无ＤＭ和ＡＭＩ病人６７例（ＮＤＭ－ＡＭＩ组）进行比较研究，结果显示：两组的肌酸磷酸激酶（ＣＰＫ）峰值、心电国科ＱＲＳ记分均无显著性差异，但ＤＭ－ＡＭＩ组住院期间的死亡率及严重心脏事件的发生率均高于ＮＤＭ－ＡＭＩ组，梗塞后４周和５个月时的左室舒张末容量（ＬＶＥＤＶ）及收缩末容量（ＬＶＥＳＶ）显著高于ＮＤＭ－     

卡维地洛和美托洛尔治疗急性心肌梗死伴心功能不全的对比研究

目的:比较卡维地洛和美托洛尔治疗急性心肌梗死(AMI)伴心功能不全患者的疗效和安全性。方法:107例AMI伴左心室收缩功能减退患者以1:1随机分为卡维地洛组(54例)和美托洛尔组(53例)。测定治疗前后临床心功能分级、血压、心率、左心室功能及肾功能和血糖、血脂水平。结果:两组治疗后NYHA心功能分级均改善,左心室射血分数增高,收缩末期容量降低(P均＜0.05)。治疗后,血糖、肌酐变化值卡维地洛组与美托洛尔组比较有统计学差异(P＜0.05),而总胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)变化值卡维地洛组与美托洛尔组比较无显著性差异。结论:卡维地洛治疗AMI伴左心功能不全患者安全,疗效与美托洛尔相似,但前者对糖代谢和肾功能可能有益。     

卡维地洛对心肌梗死后左室重塑的影响

目的：观察卡维地洛对急性心肌梗死（AMI）左室重塑的影响。方法：将80例AMI患随机分为常规治疗组（n=20)，依那普利组（n=30)及卡维地洛组（n=30)在AMI后1周，24周用超声心动图分别测定3组病人的左房内径（LA），左室舒张末期内径（LVDd)，左室收缩末期内径（LVDs)，室间膈舒张末期厚度（IVSd)，左室后壁舒张末期厚度（LVPWd)，计算左室重量（LWM），左室重量质数（LVMI）及左室射血分数（LVEF）。结果：AMI后24周，卡维地洛组和依那普利组与常规治疗组比较LA，LVDd,IVDs均明显缩小，IVSd,LVPWd,LVM及LVMI明显减小，而LVEF明显升高（P＜0．01），以上指标卡维地洛组与依那普利组比较无显性差异（P＞0．05），结论：卡维地洛可以防治AMI后左室重塑，改善心功能，其作用与依那普利相同。     

急性心肌梗死与左室重构

急性心肌梗死(AMI)后左室发生细胞学,分子学及细胞间质的变化,进而引起左室在大小、形态、组织结构和功能状态的改变,此即目前许多研究所提及的AMI后的左室重构.AMI后左室的重构贯穿于整个病程的始终,成为影响AMI患者近远期预后的主要原因之一.     

年龄对急性ST段抬高型心肌梗死患者左室射血分数的影响

目的:分析年龄对急性ST段抬高型心肌梗死患者(STEMI)左室射血分数(LVEF)的影响.方法:收集急性STEMI患者245例,根据年龄分为5组:≤50岁组(49例)、51～60岁组(70例)、61～70岁组(62例)、71～ 79岁组(50例)、≥80岁组(14例);对临床基线资料(包括年龄、性别、高血压、糖尿病、高血脂、吸烟史、超急性期及急性期ST段抬高导联数、入院时及入院12～72 h肌钙蛋白、Killip分级、LVEF、是否接受冠状动脉介入治疗(PCI)和住院期间死亡等)进行比较分析.结果:多元线性回归分析显示,LVEF与年龄(P＜0 05)和肌钙蛋白(P＜0.05)呈负相关,随着年龄增长,LVEF降低;随着肌钙蛋白的增加,LVEF降低.在≤50岁组LVEF显著高于其余各年龄组(均P＜ 0.05),而≥80岁组LVEF则显著低于其余各组(均P＜0.05).≥80岁组KilliP分级≥Ⅱ级者显著高于其余各组(均P＜0.05).≥80岁组患者的住院期间病死率显著高于≤50岁组、51～60岁组、61～ 70岁组(均P＜0.05).结论:年龄可作为影响急性STEMI患者心功能的独立危险因素.     

Safety and efficacy of a novel calcium sensitizer, levosimendan, in patients with left ventricular failure due to an acute myocardial infarction. A randomized, placebo-controlled, double-blind study (RUSSLAN).

AIMS: To evaluate the safety and efficacy of levosimendan in patients with left ventricular failure complicating acute myocardial infarction. METHODS AND RESULTS: Levosimendan at different doses (0.1-0.4 microg x kg(-1) x min(-1)) or placebo were administered intravenously for 6h to 504 patients in a randomised, placebo-controlled, double-blind study. The primary end-point was hypotension or myocardial ischaemia of clinical significance adjudicated by an independent Safety Committee. Secondary end-points included risk of death and worsening heart failure, symptoms of heart failure and all-cause mortality. The incidence of ischaemia and/or hypotension was similar in all treatment groups (P=0.319). A higher frequency of ischaemia and/or hypotension was only seen in the highest levosimendan dose group. Levosimendan-treated patients experienced lower risk of death and worsening heart failure than patients receiving placebo, during both the 6h infusion (2.0% vs 5.9%; P=0.033) and over 24h (4.0% vs 8.8%; P=0.044). Mortality was lower with levosimendan compared with placebo at 14 days (11.7% vs 19.6%; hazard ratio 0.56 [95% CI 0.33-0.95];P =0.031) and the reduction was maintained at the 180-day retrospective follow-up (22.6% vs 31.4%; 0.67 [0.45-1.00],P =0.053). CONCLUSION:s Levosimendan at doses 0.1-0.2 microg x kg(-1) x min(-1) did not induce hypotension or ischaemia and reduced the risk of worsening heart failure and death in patients with left ventricular failure complicating acute myocardial infarction.     

多普勒超声心动图评价急性心肌梗塞后左室重构及心功能改变

应用多普勒超声心动图对56例不同部位急性心肌梗塞（AMI）后患者及40例正常人左室结构（LVR）、收缩舒张功能参数进行对比分析研究。结果显示AMI后患者左室舒张及收缩末期内径、左心室舒张末期容积、左心室收缩末期容积、左室射血前期与射血时间比、舒张晚期峰值血流速度、A峰面积增大；射血分数、短轴缩短率、舒张早期峰值血流速度、E峰／A峰面积则降低，两组间比较有极显著性差异（P＜0．01）。认为AMI后患者心脏不同程度的发生了LVR及收缩舒张功能减退。     

老年急性心肌梗塞溶栓治疗对左心室功能的改善作用

目的 :评价链激酶溶栓治疗老年急性心肌梗塞 (AMI)对左心室功能的影响。方法 :应用二维超声心动图对 2 9例 AMI接受链激酶溶栓治疗和 2 1例未溶栓的 AMI患者 ,分别在急性期及 6个月后随访时测量并计算左心室容积 (EDV和 ESV) ,射血分数 (EF)等参数。结果 :急性各组心功能无差异。随访期再通组 EF值明显增加 ,且明显高于未通组和未溶栓组。结论 :链激酶溶栓能明显减轻老 AMI患者的左心室扩张 ,改善左心室功能和长期预后     

Abciximab and left ventricular thrombus formation in early period of acute myocardial infarction treated with successful primary stenting

Background Left ventricular (LV) thrombus related to acute myocardial infarction (AMI) has been rarely diagnosed since primary stenting has become the routine treatment. The salvage of myocardium at risk is considered as a reason for low frequency of this complication. The impact of glycoprotein IIb/IIIa inhibitors on LV thrombus formation remains unknown. This study investigated the relationship between abciximab treatment and presence of LV thrombus in the first few days after primary stenting. Methods and results A total of 3,078 patients with AMI, who underwent successful primary stenting, were retrospectively analyzed. There were 1,614 patients, who received abciximab and 1,414 treated without it. All patients received aspirin and clopidogrel. LV thrombus was diagnosed by two-dimensional echocardiography within 3–5 days after invasive treatment. This complication appeared equally frequently in both the abciximab and no-abciximab group (2.9% vs. 2.1%, respectively). According to results of multiple log-regression analysis, both groups did not differ in predictors of thrombus formation, such as infarct size and degree of LV dysfunction. Treatment with abciximab was not proved to be an independent predictor of LV thrombus absence. Conclusion Abciximab does not have a direct influence on LV thrombus formation in the early period of AMI.     

急性心肌梗死合并左心室附壁血栓患者经皮冠状动脉介入术后的抗栓治疗

目的分析急性心肌梗死（AMI）并发左心室附壁血栓（LvT）行经皮冠脉介入治疗（PCI）患者的临床特征及抗栓治疗。方法收集煤炭总医院2005年8月至2012年2月确诊为急性心肌梗死并发左室附壁血栓并行PCI治疗的12例患者的临床资料,对其进行回顾性分析。结果广泛前壁心肌梗死、前壁心肌梗死9例（75％）,左室射血分数低于40％共7例（58％）,冠脉造影检查三支及以上血管病变7例（58％）。6例给予华法林、阿司匹林、氯吡格雷三联抗栓,2例给予西洛他唑、阿司匹林及氯吡格雷三联抗血小板治疗,随访期间血栓均消失。4例双联抗血小板治疗者l例发生脑梗死后加用华法林,3例患者血栓消失,1例血栓机化。12例患者均未出现严重出血现象。结论急性心肌梗死并发左心室附壁血栓并接受PCI治疗患者,充分衡量获益及出血风险,按照个体化原则给予抗栓治疗安全有效。     

急性前壁心肌梗死后梗死相关血管延迟开通对晚期左室重构的影响

目的探讨急性前壁心肌梗死后,延迟经皮冠状动脉血运重建术(PCI)使梗死相关血管(IRA)开通,对心梗晚期左室重构的影响.方法选择64例急性前壁、前间壁及广泛前壁Q波性心梗后病情稳定,发病10～21天冠脉造影证实左前降支完全闭塞者,依据是否接受成功PCI,分为成功PCI组和对照组,分别于急性期、术后2个月和6个月应用超声心动图随访左室腔大小、左室功能和室壁活动异常,并观察6个月期间心力衰竭事件的发生情况.结果心梗后2个月两组左室射血分数(LVEF)、左室收缩末期容积指数(LVESVI)、左室舒张末期容积指数(LVEDVI)和室壁活动异常(VWMA)积分与急性期相比无明显差异(P＞0.05),急性期和2个月时两组上述各指标之间相比差异也无显著性(均P＞0.05).6个月时两组LVEF和VWMA积分与急性期和2个月相比无明显差异(P＞0.05),但对照组LVEDVI和LVESVI较急性期明显增大(P＜0.01,P＜0.05),且与成功PCI组相比差异具有显著性(P＜0.01,P＜0.05).6个月随访期间心力衰竭事件发生率对照组为19%,成功PCI组2%,但差异缺乏统计学意义(P＞0.05).结论急性前壁心梗后IRA延迟开通能明显减少心梗后晚期的左室重构,而对心梗后早期左室重构的影响不大.延迟PCI可能有利于减少心梗后远期心力衰竭事件的发生.     

The relationships between cardiovascular magnetic resonance imaging variables of acute myocardial infarction and both left ventricular dysfunction and immediate postreperfusion ST segment recovery

Objective

The aim of this study is to explore the relationships between cardiovascular magnetic resonance imaging (CMR)-determined variables of acute myocardial infarction and both left ventricular (LV) dysfunction and immediate postreperfusion ST segment recovery.

Methods

In 79 patients with first acute myocardial infarction, 8 different ST segment recovery (STR) variables were measured 30 and 60 minutes after percutaneous coronary intervention. Cardiovascular magnetic resonance imaging was performed 5 ± 2 and 104 ± 11 days after admission. Using k-means cluster analysis, 3 CMR risk groups for LV dysfunction (low LV ejection fraction at baseline and follow-up) were identified based on combinations of infarct size (IS), infarct transmurality, and microvascular obstruction. Stepwise discriminant analysis was used to determine which STR variable best discriminated between CMR risk groups.

Results

Baseline LV ejection fraction improved in all groups but remained lowest in the high-risk group (41% ± 7% and 44% ± 6%), as compared with the intermediate (51% ± 5% and 56% ± 5%) and low-risk groups (56% ± 7% and 58% ± 5%). Infarct size was significantly different among the groups (34% ± 5%, 19% ± 4%, and 6% ± 4%; P < .001) and mainly determined the effect on LV dysfunction. Of all STR variables, worst lead residual ST deviation 30 minutes after reperfusion accurately discriminated between the high- and combined low-/intermediate risk groups.

Conclusion

Worst lead residual ST deviation 30 minutes after reperfusion allows accurate identification of patients at high risk for LV dysfunction, which was mainly related to IS rather than transmurality or microvascular obstruction.     

心肌肌钙蛋白T与急性心肌梗死患者左心室功能的关系

目的探讨急性心肌梗死（AMI）后血清心肌肌钙蛋白T（cTnT）峰值与心功能、左室射血分数（LVEF）的关系。方法分别测定了24例急性前壁心肌梗死患者的cTnT、心功能、LVEF、EDV、ESV。结果所有前壁AMI患者的cTnT峰值与心功能成等级相关，与LVEF成负相关，与EDV、ESV成正相关；随访6个月，3例死于心衰的病人cTnT峰值均＞15μg／L（平均为17．2±1．9）μg／L），LVEF值下降者的cTnT峰值在8～15μg／L之间，LVEF值升高者的cTnT峰值均＜μg／L。结论前壁AMI后cTnT峰值越高，心功能越差，预后也越差。     

急性心肌梗死后左心室重构及其防治

本文简述了急性心肌梗死后左心室重构的发生机制、时间、后果、影响因素及防治措施等     

MMP-9和TIMP-1与急性心肌梗死后左心室重构的关系

目的探讨急性心肌梗死(AMI)患者血清基质金属蛋白酶-9(MMP-9)和金属蛋白酶组织抑制因子-1(TIMP-1)水平的变化及其与AMI后近期左心室重构(LVRM)和功能的关系。方法选择首次发病AMI患者71例,其中31例(A组)于发病12h之内(5.7±1.8)h入院给予直接经皮冠状动脉介入治疗(PCI);余40例于发病12h之后入院,待病情稳定后随机分为两组,B组20例于发病后(5.6±2.8)d行延迟PCI,C组20例给予内科保守治疗。另设正常对照组(D组)。ELISA法测血清MMP-9、TIMP-1浓度。二维超声心动图计算舒张末期容积指数(EDVI)、收缩末期容积指数(ESVI)、射血分数(EF)和室壁运动指数(WNSI)。结果EDVI、ESVI、EFA组显著优于B、C组(P<0.05);B组显著优于C组(P<0.05)。WNSIA、B组明显改善,C组恶化。A、B、C组30d时MMP-9浓度与EDVI、呈正相关(分别为r=0.48、0.54、0.63,P<0.05),与EF呈负相关(分别为r=-0.46、-0.53、-0.62,P<0.05)。结论AMI后早期血清MMP-9浓度即升高,LVRM过程中MMP-9浓度与EDVI、呈正相关,与EF呈负相关。     

Transient global left ventricular dysfunction in a localized myocardial infarction related to occlusion of the distal left anterior descending artery

In some patients with acute myocardial infarction (MI), wall motion in the noninfarcted area declines globally despite localized myocardial damage. In most, an infarct-related lesion is the proximal part of the left anterior descending artery (LAD). Previous studies have reported that hypokinesis of remote myocardium may be related to multivessel disease, impaired coronary flow, or coronary flow reserve in nonculprit arteries. This report describes the case of a 53-year-old man who presented with severe global left ventricular (LV) dysfunction after an acute MI associated with distal LAD occlusion. Follow-up echocardiographic examination revealed nearly normalized LV function 5 days after the episode. We discuss a plausible mechanism of dysfunction of noninfarcted myocardium.     

梗死相关血管晚期开通对急性心肌梗死后左室功能的影响

目的探讨急性前壁心肌梗死后延迟经皮冠状动脉血运重建术(PCI)使梗死相关血管(IRA)开通对心梗晚期左室功能的影响。方法选择64例急性前壁、前间壁及广泛前壁Q波性心梗后病情稳定,发病10～21d冠脉造影证实左前降支完全闭塞者,依据是否接受成功PCI,分为成功PCI组和对照组,分别于急性期、术后2个月和6个月应用超声心动图随访左室腔大小、左室功能和室壁活动异常,并观察6个月期间心力衰竭事件的发生情况。结果心梗后2个月两组左室射血分数(LVEF)、左室收缩末期容积指数(LVESVI)、左室舒张末期容积指数(LVEDVI)和室壁活动异常(VWMA)积分与急性期相比无明显差异(P>0.05),急性期和2个月时两组上述各指标之间相比差异也无显著性(均P>0.05)。6个月时两组LVEF和VWMA积分与急性期和2个月相比无明显差异(P>0.05),但对照组LVEDVI和LVESVI较急性期明显增大(P<0.01,P<0.05),且与成功PCI组相比差异具有显著性(P<0.01,P<0.05)。6个月随访期间心力衰竭事件发生率对照组为19%,成功PCI组2%,但差异缺乏统计学意义(P>0.05)。结论急性前壁心梗后IRA延迟开通能明显减少心梗后晚期的左室重构,而对心梗后早期左室重构的影响不大。延迟PCI可能有利于减少心梗后远期心力衰竭事件的发生。