链激酶溶栓治疗急性心肌梗死对左心室功能的改善作用

为评价链激酶溶栓治疗急性心肌梗死（ＡＭＩ）对左心室功能的影响，应用二维超声心动图对２６例接受链激酶溶栓治疗的ＡＭＩ患者和２７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）以及室壁运动指数（ＧＷＭＩ和ＲＷＭＩ）。以上各项指标在急性期时比较各组无显著性差异；在随访期再通组ＥＦ值明显高于未通组和未溶栓组，再通组左室容量减小。急性期各组心功能无差异，随访时再通组心功能较未通组显著改善。提示:链激酶溶栓能明显减轻ＡＭＩ患者的左心室扩张，改善左心室功能和长期预后     

急性心肌梗塞后左室舒张功能影响因素的探讨

为探讨急性心肌梗塞（ＡＭＩ）左室舒张功能的变化及影响因素，我们用脉冲多普勒超声心动图测量了７２例ＡＭＩ患者的左室舒张功能，并用多元逐步回归对其影响因素进行了分析。结果表明，７２例病人中Ｅ／Ａ＜１者４１例，占５６．９％。ＡＭＩ后左室舒张功能除受年龄影响外，梗塞面积的大小直接影响左室舒张功能，但与梗塞部位无关，梗塞前心绞痛可减轻梗塞后左室舒张功能的损害，是通过减小梗塞面积而实现的。溶栓治疗可以改善心肌梗塞后的左室舒张功能。     

Coronary angioplasty after intravenous streptokinase in acute myocardial infarction: influence of restenosis on clinical outcome and left ventricular function

The importance of recurrence of stenosis on clinical outcome and left ventricular function was studied in a consecutive series of patients with acute evolving myocardial infarction (maximal duration of pain 4 h) and thrombolysis (1.5 x 10(6) units of streptokinase intravenously over 60 min) with recanalized single-vessel disease and subsequent successful coronary angioplasty. Coronary angioplasty was performed in 76 patients between 24 hours and 8 days (mean interval 3.3 days) after thrombolysis and was successful in 86% (65/76). The in-hospital reinfarction rate was 5.2% (2 acute and 2 in-hospital reinfarctions). Repeat angiography after a mean interval of 5.9 months revealed a 39% (24/62) restenosis rate (21 restenoses, 3 reocclusions). Restenoses were associated with significantly more clinical complaints (21% vs. 62%; p less than 0.001). Left ventricular function analysis showed significant improvement in the mean global ejection fraction (6.6 +/- 6.0%; p less than 0.001) and mean regional wall motion of the infarct zone (6.2 +/- 8.2%; p less than 0.01) only in patients without restenosis. Recovery of left ventricular function was more evident in inferior than in anterior wall infarctions. In contrast, patients with restenosis had no change in left ventricular function. Thus, the present study demonstrates the adverse influence of restenosis on recovery of left ventricular function and clinical outcome.     

Emergency coronary angioplasty in patients with severe left ventricular dysfunction or cardiogenic shock after acute myocardial infarction

Emergency percutaneous transluminal coronary angioplasty (PTCA) was performed during an acute myocardial infarction (AMI) after either systemic or intracoronary thrombolytic therapy in six patients with severe ischaemic left ventricular dysfunction or cardiogenic shock, among 37 patients (17%) who were treated with PTCA during AMI over a 13-month period. Thrombolytic therapy with streptokinase (1.5 x 10 Units) was initiated after a mean (+/- SD) time delay of 5.5 +/- 1.3 h from the onset of symptoms. The infarct-related artery was found to be occluded (TIMI grade 0-1) in three patients and partially reperfused (TIMI grade 2) in the remaining patients at baseline coronary angiography. Intracoronary administration of urokinase (100-200,000 Units) was ineffective in those patients failing systemic thrombolysis and resulted in only a slight increase of residual lumen in three patients. The coronary artery could be opened by a guidewire mechanical technique in patients with persistent coronary artery occlusion and coronary dilation could be done in all patients. The mean percentage diameter stenosis of the infarct-related vessel was reduced from 98.8 +/- 2% to 27 +/- 11% (P less than 0.005). After the procedure, left ventricular ejection fraction increased from 27 +/- 8% to 41 +/- 7% (P less than 0.02), systemic blood pressure and cardiac index increased respectively from 86 +/- 10 to 126 +/- 14 mmHg (P less than 0.005) and from 2.2 +/- 0.6 to 3.3 +/- 0.6 (P less than 0.01). Left ventricular end-diastolic pressure decreased from 26 +/- 8 to 18 +/- 3 mmHg (P less than 0.05). Severe mitral regurgitation was relieved in one patient.(ABSTRACT TRUNCATED AT 250 WORDS)     

Spontaneous recovery of left ventricular function following acute anterior myocardial infarction

Four patients with acute anterior wall myocardial infarction showing spontaneous and marked improvement in systolic left ventricular function are described. All 4 patients showed abnormal Q waves and severe wall motion abnormalities soon after acute infarction. In all 4 patients, at least some regeneration of R-wave forces occurred and the regional wall motion in the involved area of the left ventricle improved dramatically without coronary angioplasty or surgical revascularization during the intervening period. The improvement in left ventricular function was attributed to spontaneous increase in nutrient flow to the involved area. It is concluded that Q waves and severe wall motion abnormalities do not necessarily indicate irreversible scar formation.     

Coronary collaterals and left ventricular function early after acute transmural myocardial infarction

The coronary collateral circulation and ventricular function,segmental wall motion and infarct size, were investigated fromhemodynamic and angiographic data in 126 patients with acutetransmural myocardial infarction and complete obstruction ofa major coronary vessel. The patients were divided into twogroups: 74 with obstruction of the right coronary artery and52 with obstruction of the left anterior descending artery.The collateral circulation was rated as absent, poor, fair oradequate: two weeks after infarction, collateral vessels wereobserved in only 27% (poor 15.4%, fair 5.8%, adequate 5.8%)of the patients with an anterior myocardial infarction and inonly 35% (poor 13.5%, fair 16.4%, adequate 4.5%) of the patientswith an inferior myocardial infarction. In both groups of patients, the presence of collateral vesselshad no significant influence on the following parameters: leftventricular performance (left ventricular end-diastolic pressure,left ventricular enddiastolic volume, ejection fraction andmean velocity of fiber shortening), extent of abnormally contractingsegment and segmental wall motion. After anterior myocardialinfarction, there was an insignificant trend to lesser myocardialdamage in patients with coronary collaterals. Thus, coronary collaterals are infrequent in patients with acutetransmural myocardial infarction and total obstruction of acoronary vessel; in these patients we conclude that the collateralshave no effect either on left ventricular function or on thesize of the infarction.     

急性心肌梗死后择期冠脉介入治疗对左室重构和心功能的影响

目的探讨急性心肌梗死（AMI）后择期经皮冠状动脉介入（PCI）治疗对左心室重构和心功能的影响。方法112例AMI患者,分为PCI组和药物治疗组,PCI组于发病后1～2周内行PCI治疗,所有患者于发病后1～2周时、4周和24周时行超声心动图（UCG）检查,观察左心室收缩末容积指数（LVESVI）、左心室舒张末容积指数（LV-EDVI）和左室射血分数（LVEF）。结果行PCI治疗后,血管再通率为100%,术后4周和24周的LVESVI、LVEDVI和LVEF均明显优于术前,与药物治疗组比较有显著性差异（P<0.05）。结论AMI后择期PCI治疗能够有效抑制左心室重构,改善心功能。     

急性心梗心电图QRS波终末变形与左室功能变化的研究

目的探讨急性心肌梗死患者心电图QRS波终末变形情况与左心室功能变化的关系。方法根据入院心电图将急性心梗患者分成QRS终末变形阳性(QRS+)组(n=22)与QRS终末变形阴性(QRS-)组(n=46),于经皮冠状动脉介入术后2周与6个月时行超声心动图检查。结果术后6个月时QRS-组左心室舒张末期容积指数(LVEDVI)、左室收缩末期容积指数(LVESVI)及室壁活动异常积分(VWMA)明显小于QRS+组p<0.05),而左室射血分数(LVEF)显著高于QRS+组(p<0.05)。结论心电图QRS终末变形可作为急性心梗后左室重构和左室功能变化的预测因子之一。     

The acute effects of intravenous nisoldipine on left ventricular function within 24 h after acute myocardial infarction.

Nisoldipine is a calcium antagonist with potent coronary vasodilating effects in patients with chronic stable angina pectoris. We studied the acute effects of nisoldipine in six patients within 24 h (mean 14 +/- 4 h) after the onset of myocardial infarction. Nisoldipine was administered as a 4.5 micrograms kg-1 intravenous bolus over 3 min followed by intravenous infusion of 0.2 microgram kg-1 min-1 during 60 min. Radionuclide angiography, cardiac output and intra-arterial blood pressure measurements were performed before and during nisoldipine. Left ventricular ejection fraction increased from 48.3 +/- 10.3% to 55.3 +/- 11.8% (P = 0.034) during nisoldipine infusion. Regional wall motion score changed during nisoldipine infusion from 3.3 +/- 2.5 to 1.8 +/- 2.6 (P = 0.027). Cardiac output increased from 5.5 +/- 1.0 to 7.3 +/- 1.3 l min-1 (P = 0.0001). Heart rate increased from 78 +/- 12 to 88 +/- 11 beats.min-1 (P = 0.004). Mean arterial blood pressure decreased from 91.7 +/- 20.2 to 78.7 +/- 13.1 mmHg (P = 0.038). The rate-pressure product did not change significantly during nisoldipine infusion. It is concluded that nisoldipine improves global and regional left ventricular function in patients with acute myocardial infarction within the first 24 h. Our findings suggest that this effect is achieved without increasing myocardial oxygen demand.     

Simultaneous assessment of segmental and global left ventricular function by two-dimensional echocardiography in acute myocardial infarction

Both segmental and global left ventricular performance were assessed simultaneously in 29 patients with acute myocardial infarction using two-dimensional echocardiography. Comparisons were made between left ventricular wall motion versus peak CK-MB, site of infarction, and occurrence of heart failure. Two-dimensional echocardiography identified areas of dyssynergy which corresponded to electrocardiographic areas of infarction in 89% of all cases. Patients with heart failure had more dyssynergic segments, and these segments manifested more severe dyssynergy than patients without heart failure. Patients with severe global dysfunction manifested higher peak CK-MB values, and those with anterior infarction had more global dyssynergy than did those patients with inferior infarction. These observations suggest that two-dimensional echocardiography is a useful technique for localization and assessment of segmental and global dyssynergy in acute myocardial infarction. Information so derived correlates with the clinical status of patients with acute myocardial infarction, and may offer important insights into both prognosis and treatment.     

Congestive heart failure with preserved left ventricular systolic function after acute myocardial infarction: clinical and prognostic implications

AIMS: To characterise the prevalence, in-hospital complications, management, and long-term outcome of patients with congestive heart failure but preserved left ventricular systolic function after acute myocardial infarction. METHODS: 3166 consecutive patients screened for entry in the Bucindolol Evaluation in Acute Myocardial Infarction Trial with definite acute myocardial infarction and echocardiographic assessment of left ventricular systolic function were included between 1998 and 1999 in this prospective observational study. Main outcome measures were occurrences of in-hospital complications and all cause mortality. RESULTS: Congestive heart failure was seen during hospitalisation in 1464 patients (46%), 717 patients had preserved left ventricular systolic function (wall motion index > or =1.3 corresponding to ejection fraction > or =0.40), and 732 patients had systolic dysfunction (wall motion index <1.3). One year mortality in patients with no heart failure, heart failure with preserved systolic function, and heart failure with systolic dysfunction were 6, 22 and 35%, P<0.0001. Unadjusted risk of death from all causes associated with heart failure and preserved systolic function was 3.3 (95% CI 2.8-4.0), and after adjustment for baseline characteristics and left ventricular systolic function in multivariate Cox proportional hazards analysis the risk was 2.1 (95% CI 1.7-2.6), P<0.0001. CONCLUSIONS: Congestive heart failure is frequently present in patients with preserved left ventricular systolic function, and is associated with increased risk of in-hospital complications and death following acute myocardial infarction.     

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－     

Bone marrow stimulation and left ventricular function in acute myocardial infarction

BACKGROUND: Experimental studies have demonstrated that bone marrow stem cells can migrate into peripheral blood and regenerate damaged myocardium. HYPOTHESIS: Bone marrow stimulation might improve myocardial functional recovery after acute myocardial infarction (AMI). METHODS: In all, 104 consecutive patients with anterior wall AMI treated by primary coronary angioplasty and stenting within 12 h after onset, and who underwent left ventriculography on admission and 6 months after discharge, were studied. Among these, 23 patients (Group 1) demonstrated transient appearance of immature blood cells including myelocytes, promyelocytes, and myeloblasts during hospital stay. Thirty-eight matched patients in whom no immature blood cells were detected were studied as a control group (Group 2). RESULTS: There was no significant difference in baseline characteristics between the two groups. There was no significant difference in left ventricular ejection fraction (EF) on admission between Group 1 (33 +/- 12%) and Group 2 (34 +/- 8%). In contrast, EF was significantly better in Group 1 (47 +/- 12%) than in Group 2 (40 +/- 10%, p = 0.016) 6 months after discharge. CONCLUSION: The study suggests significantly greater improvement in left ventricular function in patients with AMI with sign of bone marrow stimulation than in matched patients with no sign of bone marrow stimulation.     

Effectiveness of intravenous streptokinase on infarct size and left ventricular function in acute myocardial infarction. Prospective and randomized study

Within 3 h after the onset of symptoms of myocardial infarction, 64 patients were randomly assigned to receive either a 1-h intravenous infusion of 1,500,000 IU of streptokinase (SK) or a conventional therapy. Infarct size was estimated in CK gram equivalent (CKg) by measurement of CK-MB every 3 hours during a 48-h period. Enzymatic study revealed that myocardial infarction of the SK group was significantly smaller (61.4 +/- 45 vs. 89.4 +/- 56 CKg, p less than .05). Angiograms were performed at early stage and five weeks after myocardial infarction. At first coronary angiogram, the infarct-related vessel was open in 82% in the SK group versus 12% in controls. The SK group had higher global ejection fraction at second angiogram (57 +/- 11% vs. 49 +/- 11%, p less than .02), but differences in regional wall motion were not significant. By analysis according to patency or occlusion of infarct-related vessel, global and regional ejection fractions were significantly better at first and at second angiograms in all patients and in anterior infarctions with a patent infarct-related coronary artery. There was no significant difference for inferior infarction. We conclude that intravenous streptokinase infusion early after the onset of myocardial infarction reduces infarct size and improves left ventricular function, chiefly in anterior infarction. This benefit appears to be closely correlated to patency of infarct-related vessels.     

The acute effects of intravenous nisoldipine on left ventricular function 24 to 72 hours after uncomplicated acute myocardial infarction

Summary The acute effects on left ventricular function of nisoldipine were studied in six patients 56±12 hours (range 44 to 72 hours) after the onset of uncomplicated acute myocardial infarction. Nisoldipine was administered as a 4.5 g/kg intravenous bolus over 3 minutes followed by an infusion of 0.2 g/kg during 60 minutes. Radionuclide angiography and two-dimensional echocardiography were performed before and during infusien with nisoldipine. The left ventricular ejection fraction increased significantly from 38%±10% to 49%±10% (P=0.028) during nisoldipine infusion. Regional wall motion index was determined both by radionuclide and by two-dimensional echocardiography and showed a significant change during nisoldipine infusion from 1.9±0.3 to 1.5±0.3 (p=0.028, radionuclide angiography) and from 0.7±0.2 to 0.3±0.2 (p=0.043, two dimensional echocardiography). Heart rate increased significantly from 78±12 min^-1 to 92±13 min^-1 (p=0.028), but mean double product did not change significantly during nisoldipine infusion. It is concluded that nisoldipine significantly improves global and regional left ventricular function in patients shortly after acute myocardial infarction. This beneficial effect may, however, be partially offset by an increase in heart rate. Since mean double product did not change, it is suggested that nisoldipine may improve coronary blood flow in patients with acute myocardial infarction.     

心肌梗死患者心功能的预测因素

21世纪,心血管疾病已经超越传染病和肿瘤成为人类健康的头号杀手,其中最为凶险的就是急性心肌梗死。统计资料显示,全球每年有1700万人死于心血管疾病,其中一半以上死于急性心肌梗死。目前研究证实,心梗后约有56％的患者会出现心功能下降,而1／3的患者会发展成为心力衰竭。心力衰竭不但会直接影响患者的生存质量,同时又是介入治疗后晚期血栓形成的重要预测因素,因此,临床工作中全面了解心梗患者心功能的预测因素,积极进行处理事关重要。     

急诊血运重建对急性心肌梗死左心室功能的影响

目的应用二维超声心动图及多普勒组织成像（Doppler tissue imaging,DTI）评价急诊血运重建（包括静脉溶栓或者急诊冠状动脉支架置入术）对急性心肌梗死（acute myocardial infarction,AMI）左心室收缩和舒张功能的影响。方法入院后根据AMI患者治疗方法分为常规组和治疗组。常规组30例给予内科常规治疗;治疗组20例在内科常规治疗基础上实施静脉溶栓或急诊冠状动脉支架置入术。应用DTI检测左心室射血分数、二尖瓣血流舒张早期流速峰值（peak velocity at early diastole,VE）和舒张晚期流速峰值（peak velocity at late diastole,VA）比值（VE／VA）,DTI成像模式检测二尖瓣环后间隔、侧壁、前壁、下壁、前间隔和后壁6个节段的收缩期运动速度峰值（peak velocity during systole,Sa）、舒张早期运动速度峰值（peak velocity at early diastole,Ea）和心房收缩期流速峰值（peak velocitv at atrial contraction,Aa）,并计算Ea／Aa比值。各取6个节段的平均值。结果所有AMI患者于发病后1周、3月末左心室射血分数、VE／VA、Sa、Ea和Ea／Aa均较对照组降低;予急诊血运重建的AMI患者于AMI发病后3个月S。和E。较本组发病后1周增高,并较未行急诊血运重建干预组（常规组）发病后3个月增高。结论AMI后左心室收缩和舒张功能受损,实施急诊血运重建可以有效改善心脏功能．应用DTI技术检测二尖瓣环运动速度可以精确反映AMI患者局部节段性心功能的恢复。     

The effects of early captopril treatment on left ventricular volumes and function in patients with and without depressed global ejection fraction after acute myocardial infarction

To determine the effects of captopril on left ventricular volumesand function in patients with and without depressed ventricularfunction following acute myocardial infarction (AMI) we studied78 patients with a first Q wave AMI and no clinical evidenceof heart failure. All patients underwent radionuclide ventriculography(RVG) on the 4th day after admission and were then randomlyassigned to receive conventional treatment alone (36 patients,control group) or with the addition of oral captopril, 25 mgthree times daily (42 patients, captopril group). RVG was repeatedone month after the baseline examination. After one month theleft ventricular ejection fraction (LVEF) significantly increasedin the captopril group (from 43.2±1.3 to 50.9±1.6%,P<0.001) and remained relatively unchanged in the controlgroup (from 47±1.3 to 49.2±1.7%, P=ns). In thecaptopril group the subgroup of patients with a baseline LVEF<45% demonstrated a significant decrease in end-systolicvolume index (ESVI) (from 53.3 ±3.2 to 42.4±2.8ml.m^–2,P<0.002) and a highly significant improvement in LVEF (from36.3±1.3 to 49.6±1.8%, P<0.00005). In the controlgroup, LVEF also increased in those in whom it was <45% (from38±1.4 to 42±2.4%, P<0.01), but the increasewas less than that in the captopril group (P<0.01), mainlydue to an increase in end-diastolic volume index (EDVI) (from78.2±4.6 to 84.6±12.3 ml.m^–2, P=ns). Inboth the captopril and control subgroups of patients with abaseline LVEF 45% there was no significant change in LVEF (from50.1±0.8 to 52.1±2.6% and 53.4±1.5 to 54.2±2.1%respectively), but there was a trend for both left ventricularvolumes to increase (EDVI: from 81.4±4.7 to 91.1±9.9ml.m^–2and 76±5.7 to 90.3±9.2 ml.m^–2; ESVI: from40.6±2.6 to 45.2 ±3.4 ml.m^–2 and 32.1±2.6to 40.1 ±3.8 ml.m^–2 respectively, all P=ns). In conclusion, our study confirmed the beneficial effect ofcaptopril on left ventricular size and function in patientswith depressed global LVEF after AMI, but there was no evidenceof a similar effect in patients with preserved global LVEF,at least during the first month of treatment.     

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     

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。