不同时段介入治疗对心肌梗死室壁瘤患者心室收缩同步性及血浆脑钠肽的影响

目的对比经皮冠状动脉介入（PCI）治疗对急性心肌梗死（AMI）后左心室室壁瘤（LVA）形成、心室收缩同步性及血浆脑钠肽（BNP）的影响。方法选择2001年1月至2004年7月收治的首次急性前壁心肌梗死及左心室造影（LVG）确定合并室壁瘤者共326例，根据PCI施行的时间分为4组：A组32例（〈3h）、B组89例（≥3h且〈6h）、C组129例（≥6h且〈12h）、D组76例（AMI后1周），4组患者于PCI后1周时行平衡法核素心室显像（ERNA），测定左室整体和局部收缩功能、舒张功能和收缩同步性功能参数及反常室壁容积指数（PVI）；AMI后6个月随访时重复测定上述参数，并随访3年，记录主要恶性心脏事件（MACE）的发生率。所有患者于发病后18h，第5天及24周测定血浆BNP质量浓度。对数据行方差分析和，检验。结果AMI后6个月随访时，A、B、C3组左心室射血分数（LVEF）较D组明显增高（F=5．81，P〈0．05），而相角程（PS）、半高宽（FWHM）明显降低（F=5．90和6．80，P均〈0．05）；A组反常容积消失病例数明显高于B、C、D组，且A组PVI明显低于B、C、D组分别为（12．08±2．07）％、（15．43±2．39）％、（16．49±2．47）％、（20．41±3．68）％，F=4．32，P〈0．05]。D组发病后18h、第5天和第24周血浆BNP质量浓度均明显高于A组（12．30±2．24）彬L与（9．85±2．60）μg／L，（9．47±1．95）μg／L与（6．65±1．56）μg／L，（5．36±1．43）μg／L与（3．27±1．12）μg／L，F=5．19，P〈0．05]，B、C组差异无统计学意义（F=5．19，P〈0．05），但均低于D组。住院期间及术后3年随访A，B，C3组梗死后心绞痛发生率和3年随访时死亡率6．25％（2／32）与3．12％（1／32），8．99％（8／89）与5．62％（5／89），9．30％（12／129）与7．76％（10／129]均低于D组21．05％（16／76）与17．11％（13／76）]∥分别为91．3和10．05，P均〈0．05。结论对AMI患者梗死相关动脉开通越早、越充分，才能越有效地抑制并逆转LVA的形成，提高左心室功能，最终改善患者预后。

Effect of percutaneous coronary intervention on ventricular systolic synchrony and brain natriuretic peptide in acute myocardial infarction patients with aneurysm

Objective To evaluate the reversed effect on the left ventricular aneurysm (LVA) for-mation and influence on systolic performance and synchrony using pereutaneous coronary intervention (PCI) therapy in patients with acute myocardial infarction (AMI) at different time intervals equilibrium radionu-clide angiography (ERNA).Methods A total of 326 patients with primary anterior AMI accompanied LVA diagnosed by left ventricular graphy were enrolled in this study from January 2001 to July 2004.They were divided into 4 groups according to the time accepting PCI.Group A (<3 h, n=32), group B (≥3 h and <6 h, n=89, group C (≥6 h and < 12 h, n=129 and group D (> 1 week, n=76).The parame-ters of the paradox volume image of ventricular movement on the dynamic cine of cardiac blood pool, and the paradox volume index (PVI) as well as the parameters of left ventricular systolic function (LVSF), left ventricular diastolic function (LVDF) and left ventricular systolic synchrony (LVSS) were measured by ERNA with the ventricular phase analysis (PA) at 1st week and 6th month after AMI.The plasma brain na-triuretic peptide (BNP) was measured in 18th hour, 5th day and 24th week after AMI.During 3-year fol-low-up, the major adverse cardiac events (MACE) were recorded.Analysis of variance and χ~2-test were used.Results At 6th month post AMI, the left ventricular ejection fraction (LVEF) in group A, B and C was increased than that in group D, hut phase shift (PS) and full width at half maximum (FWHM) were decreased (F=5.90, 6.80, all P <0.05, respectively).Meanwhile the PVI in group A was lower than that in groupB, C and D ((12.08±2.07)%, (15.43±2.39)%, (16.49±2.47)%, (20.41±3.68)%, F=4.32, P<0.05).At 18th hour, 5th day and 24th week after AMI, the values of BNP in group D were higher than those in group A ((12.30±2.24)μg/L vs (9.85±2.60)μg/L, (9.47±1.95)μg/L vs (6.65±1.56)μg/L, (5.36±1.43)μg/L vs (3.27±1.12)μg/L, F=5.19, P <0.05).There was no difference between group B and C.Within the 3-year follow-up, the mortality in group A, B, and C was significantly lower than that in group D: 3.12% (1/32), 5.62% (5/89), 7.76% (10/ 29) vs 17.11% (13/76), χ~2=10.05, P<0.05).Conclusion The early, fully and permanently open-ing of infarction related artery can effectively inhibit the left ventricular remodeling process, improve its function, prevent LVA formation, and finally improve the prognosis.