二维超声心动图诊断首次急性心肌梗死后室壁运动情况的价值探讨

目的 探讨首次急性心肌梗死(AMI)患者出院前二维超声心动图检查对长期预后危险度分层的价值.方法 281例首次AMI患者出院前常规进行二维彩色超声心动图检查,并对患者进行2～10年随访,平均随访5.5年.结果 281例患者有室壁运动异常者152例(54.1%),其中室壁瘤49例,无室壁瘤的室壁运动异常者103例.室壁运动正常者为127例.患者出院后发生再梗死78例,充血性心衰64例,心源性死亡31例.室壁瘤组患者长期预后发生再梗死26例,充血性心衰23例,心源性死亡9例.该组患者的预后明显较有无室壁瘤的室壁运动异常组和室壁运动正常者组更差,差异具有统计学意义.结论 严重室壁运动异常(室壁瘤)是影响AMI长期预后主要因素.出院前二维超声心动图检查对AMI长期预后危险分层具有实际意义.

Value of two dimensional echocardiogram for ventricular wall motion in first acute myocardial infarction patients

Objective To explore the prognosis of ventricular aneurysm in first acute myocardial infarction patients by predischarge hospital echocardiogram.Methods Prospective predischarge hospital two dimensional colour flow echocardiography examination were performed in 281 first acute myocradial infarction patients.Mean followup was 5.5 years(range 2 to 10 years).Results One hundred and fifty-two(54.1%)first acute myocardial infarction patients had abnormal ventricular wall motion.Among them,49 patients had ventricular aneurysm, 103 had abnormal ventricular wall motion but without ventricular aneurysm.After discharge,78 patients had recurrent myocardial infarction, 64 had congestive heart failure,and 31 had cardiogenic death.In aneurysm group, 26 cases had recurrent MI,23 had congestive heart failure and 9 cardiogenic death.Patients with aneurysm had more cardiac events than abnormal wall motion without aneurysm group and normal wall motion group after discharge.Conclusions Abnormal ventricular wall motion is the main factor affected the prognosis of AMI.Predischarge hospital echocardiogram is meaningful to risk stratification and prognosis of AMI.