心肌梗死患者室壁运动状态及梗死面积与左心房功能关系的研究

目的 评价心肌梗死患者梗死面积及室壁运动状态对左心房功能的影响,探讨影响左房功能的主要因素.方法 通过比较大面积梗死组(A组,20例)、小面积梗死组(B组,30例)及正常对照组(20例)三组间的左房功能(根据ASE推荐的16节段法,小面积<4节段;大面积>4节段),评价不同梗死面积对左房功能的影响;分析室壁运动状态(以室壁运动指数WMSI表达)与左房功能参数间的相关性;以心肌梗死患者左房开始收缩时容积指数(VpreⅠ)为因变量,应用逐步回归探讨心肌梗死后影响左房功能的主要因素.结果 ①左房最大容积指数(VmaxⅠ)、左房最小容积指数(VminⅠ)、VpreⅠ、左房主动排空容积指数(AEVI)、左房射血力指数(EFI)在对照组、A组、B组依次递增,左房被动排空分数(PEF)及膨胀指数(AEI)在对照组、A组、B组依次递减(P<0.05).②WMSI与VmaxⅠ、VminⅠ、VpreⅠ、AEVI及AEI相关性良好.③以VpreⅠ为因变量,进入回归方程的变量有WMSI、左室舒张末内径(LVDd)及E/A.结论 随着梗死面积的增大及室壁运动异常的加重,左房重构加重,左房"助力泵"功能增加,左房"管道"功能及"储器"功能减低.室壁运动状态、左室重构及左室舒张功能是影响心肌梗死后左房功能的主要因素.

Relationship between ventricular wall motion state, infarction size and left atrial function in patients with myocardial infarction

Objective To assess the influence of the wall motion state and the infarct size of myocardial on left atrial(LA) function in patients with myocardial infarction(MI), and to investigate the main determinants of LA function. Methods LA function of the small area of MI group (group A), the large area of MI group (group B) and control.group were compared,and the influence of the infarct size on LA function was evaluated. The correlation between parameters of LA function and wall motion score index (WMSI) was analyzed. Stepwise regression was made to determine the influencing factors of LA function. index (VpreⅠ),LA active emptying volume index (AEVI), LA ejection force index (EFI) of group A and group B were larger than those of control group,and the parameters of group B were also larger than those of group A(P<0.05). LA passive emptying fraction (PEF) and atrial expansion index (AEI) of group A and group B were smaller than those of control group,and the parameters of group B were also smaller than regression equation. Conclusions With the increasing of areas of infarction and the aggravating of wall motion sate,the LA remodeling aggravated. The boost pump function of LA augmented, and the function of conduit and reservoir of LA was reduced. Wall motion state, LV remodeling and LV diastolic function were the major determinants of augmented LA function in MI patients.