TIME COURSE OF LEFT-VENTRICULAR DILATION AFTER MYOCARDIAL-INFARCTION - INFLUENCE OF INFARCT-RELATED ARTERY AND SUCCESS OF CORONARY THROMBOLYSIS
TIME COURSE OF LEFT-VENTRICULAR DILATION AFTER MYOCARDIAL-INFARCTION - INFLUENCE OF INFARCT-RELATED ARTERY AND SUCCESS OF CORONARY THROMBOLYSIS
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DOI：
10.1016/0735-1097(88)90159-3
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发表时间：
1988-01-01
影响因子：
24
通讯作者：
MCKAY, RG
中科院分区：
文献类型：
--
作者：
WARREN, SE;ROYAL, HD;MCKAY, RG
心肌梗死后左心室扩张是常见的，发生迅速(在梗死后2周内)，可能是自限性的。为了解心肌梗死后左室扩张的时间进程及评价冠状动脉溶栓成功的影响，对36例急性穿壁性心肌梗死患者行核素左室容量分析。所有患者均在症状出现后7h内接受了心导管、冠状动脉造影和溶栓治疗。冠脉闭塞部位左前降支17例，右冠状动脉18例，右回旋支和右回旋支搭桥闭塞1例。使用溶栓剂的尝试再通成功的有22人，发生率为5.+-。症状出现后1h。早期(平均入院后1d，n=36)、亚急性期(平均入院后11d，n=36)和晚期(平均入院后10.5个月，n=25)行门控核素心室造影术，并用几何技术测量左心室舒张末容积。整个组的左室舒张末期容量从153.+-显著增加(p<；0.01)。30毫升基线升至172。+-。45毫升(11天)至220。+-。63毫升(10.5个月)。36例患者中有20例表现为左室舒张末期容量随时间增加20%。这在7名患者中出现较早，在其他7名患者中发生在远离梗死的地方，在6名患者中显示为进行性模式。与右冠状动脉闭塞患者相比，左前降支患者左心室扩张更频繁，慢性扩张更明显(p<；0.01)。溶栓不成功的患者的扩张结果和射血分数与再通成功的患者的结果相似。结论：心肌梗死后左室扩张是一种常见的并发症，但有时是较晚出现的并发症，在前壁心肌梗死中更为常见和严重。相对较晚的溶栓(5。+-。1 h)在急性心肌梗死病程中不能阻止随后的左心室扩张，很可能是由于延迟介入。
Dilatation of the left ventricular after myocardial infarction is common, occurs rapidly (within 2 weeks of infarction) and may be self-limited. To evaluate the time course of postinfarction left ventricular dilation and to assess the impact of successful coronary thrombolysis, serial radionuclide left ventricular volume analyses were performed in 36 patients undergoing attempted thrombolysis for acute transmural myocardial infarction. All patients underwent cardiac catheterization, coronary angiography and attempted thrombolysis within 7 h of the onset of symptoms. The site of coronary occlusion was the left anterior descending coronary artery in 17 patients, the right coronary artery in 18 and, in 1 patient, occluded bypass grafts to the right and left circumflex coronary arteries. Attempted reperfusion using a thrombolytic agent was successful in 22 individuals, occurring 5 .+-. 1 h after the onset of symptoms. Gated radionuclide ventriculography was performed early (mean time 1 day after admission, n = 36), subacutely (mean time 11 days postinfarction, n = 36) and late after infarction (mean time 10.5 months, n = 25), and a geometric technique was used to measure serial left ventricular end-diastolic volume. Left ventricular end-diastolic volume for the entire group increased significantly (p < 0.01) from 153 .+-. 30 ml at baseline to 172 .+-. 45 ml (at 11 days) to 220 .+-. 63 ml (at 10.5 months). Twenty of 36 patients showed > 20% increase in left ventricular end-diastolic volume (dilation) with time. This appear early in seven patients, occurred remote from infarction in seven others and showed a progressive pattern in six. Left ventricular dilation was more frequent and chronic dilation significantly more marked (p < 0.01) in patients with left anterior descending as compared with right coronary artery occlusion. Dilation outcomes and ejection fraction for patients in whom attempted thrombolysis was not successful were similar to findings in patients for whom reperfusion was successful. It is concluded that left ventricular dilation after myocardial infarction is a common, though sometimes late-appearing complication, both more frequent and severe in anterior infarction. Relatively late thrombolysis (5 .+-. 1 h) in the course of acute myocardial infarction did not prevent subsequent development of left ventricular dilation, most probably because of delayed intervention.