Comparison of two-dimensional echocardiography with gated radionuclide ventriculography in the evaluation of global and regional left ventricular function in acute myocardial infarction.
Comparison of two-dimensional echocardiography with gated radionuclide ventriculography in the evaluation of global and regional left ventricular function in acute myocardial infarction.
复制标题
二维超声心动图与门控放射性核素心室造影评估急性心肌梗死整体和局部左心室功能的比较。
DOI：
10.1016/s0735-1097(84)80007-8
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发表时间：
1984
影响因子：
24
通讯作者：
WintersJr,WL
中科院分区：
文献类型：
--
作者：
VanReet,RE;Quinones,MA;Poliner,LR;Nelson,JG;Waggoner,AD;Kanon,D;Lubetkin,SJ;Pratt,CM;WintersJr,WL
对93例急性心肌梗死患者（66例男性，27例女性;平均年龄61岁）进行了二维超声心动图和门控放射性核素心室造影，这些患者在梗死后48小时内和10天内发生了95次急性心肌梗死。心电图梗死部位：前壁35例，后壁下壁49例，非局限性11例。放射性核素心室造影和超声心动图分别在97%和100%的前壁梗死中观察到前壁、间隔或心尖的异常运动。超声心动图显示91%的后下壁梗死患者下壁或后壁段运动异常，而放射性核素心室造影显示的比例为61%。心脏超声心动图和放射性核素心室造影测定的射血分数相关性良好（r = 0.82），从梗死后最初48小时至10天无变化（0.48 ± 0.14）。同样，室壁运动评分从最初48小时到10天变化很小，超声心动图和放射性核素心室造影射血分数≤ 0.35的患者住院死亡率分别为37%和42%。两种试验中射血分数高于0.40的患者均无死亡。超声心动图室壁运动评分也可预测死亡率（40 vs 2%;评分≤ 0.50 vs> 0.50）。81例短期存活者1年死亡率为17%。射血分数高于0.49或室壁运动评分高于0.79的患者死亡率最低（2 - 5%），射血分数低于0.36或室壁运动评分低于0.51的患者死亡率更高（36 - 63%）。因此，在急性心肌梗死中，超声心动图和放射性核素心室造影术提供了前壁梗死患者左心室功能和室壁运动的可比评估。超声心动图在检测下后壁运动异常方面更为敏感。两种技术都能够识别急性事件期间死亡风险高的患者亚组，以及1年随访期间死亡率同样高的患者亚组。
Two-dimensional echocardiography and gated radionuclide ventriculography were performed in 93 patients (66 men, 27 women; mean age 61 years) with 95 episodes of acute myocardial infarction within 48 hours and at 10 days after infarction. Electrocardiographic sites of infarction were: 35 anterior, 49 inferoposterior and 11 nonlocalized. Abnormal motion of the anterior wall, septum or apex was seen in 97 and 100% of anterior infarctions by radionuclide ventriculography and echocardiography, respectively. Abnormal motion of an inferior or posterior wall segment was seen in 91% of inferoposterior infarctions by echocardiography versus 61% seen by radionuclide ventriculography. Ejection fractions determined by echocardiography and radionuclide ventriculography correlated well (r = 0.82) and did not change from the first 48 hours to 10 days after infarction (0.48 ± 0.14). Similarly, wall motion score showed minimal change from the first 48 hours to 10 days.In-hospital mortality was 37 and 42% in patients with an ejection fraction of 0.35 or less by echocardiography and radionuclide ventriculography, respectively. No mortality was seen in patients with an ejection fraction above 0.40 by either test. The echocardiographic wall motion score was also predictive of mortality (40 versus 2%; score ≤ 0.50 versus > 0.50). The 1 year mortality rate in the 81 short-term survivors was 17%. Mortality was lowest in patients with an ejection fraction above 0.49 or wall motion score above 0.79 (2 to 5%) and worse in those with an ejection fraction below 0.36 or wall motion score below 0.51 (36 to 63%) by either technique.Thus in acute myocardial infarction, echocardiography and radionuclide ventriculography provide a comparable assessment of left ventricular function and wall motion in anterior infarction. Echocardiography appears more sensitive in detecting inferoposterior wall motion abnormalities. Both techniques are capable of identifying subgroups of patients with a high risk of death during the acute event and with an equally high mortality rate over a 1 year follow-up period.