LEFT-VENTRICULAR WALL-MOTION ABNORMALITIES IN PATIENTS WITH SUBARACHNOID HEMORRHAGE - NEUROGENIC STUNNED MYOCARDIUM
LEFT-VENTRICULAR WALL-MOTION ABNORMALITIES IN PATIENTS WITH SUBARACHNOID HEMORRHAGE - NEUROGENIC STUNNED MYOCARDIUM
复制标题
DOI：
10.1016/0735-1097(94)90008-6
复制
发表时间：
1994-09-01
影响因子：
24
通讯作者：
FUJIWARA, A
中科院分区：
文献类型：
--
作者：
KONO, T;MORITA, H;FUJIWARA, A
目标。本研究的目的是确定蛛网膜下腔出血患者的心电图异常与室壁运动之间是否存在联系。尽管蛛网膜下腔出血患者常出现类似急性心肌梗死的心电图改变，但其与室壁运动的关系尚未建立。根据入院时至少连续两个导联ST段抬高的情况，对12例蛛网膜下腔出血患者进行分类：ST段抬高7例(I组)，无ST段抬高5例(II组)。没有患者以前有心脏病病史。用中线法评价左室室壁局部运动。从蛛网膜下腔出血至左心室造影的平均时间(+/-SEM)：I组为9+/-3h，II组为10+/-1h。ST段抬高时行冠状动脉造影术以排除冠脉病变所致的室壁运动异常。用二维超声心动图评价室壁运动情况。I组患者均表现为V-4~V-6导联ST段抬高。室壁运动I组较II组显著减少(-2.48+/-0.41比-0.45+/-0.72，p<；0.02)。无一例显示心外膜冠状动脉器质性狭窄或血管痉挛，或两者兼有。超声心动图显示所有患者的室壁运动异常均有减少，但I组有1例患者在蛛网膜下腔出血后2~3周内死亡，此时V-4~V-6导联T波倒置。这些发现提示蛛网膜下腔出血和ST段抬高的患者可能表现出一过性相应的节段性室壁运动异常。神经源性顿抑心肌的发病机制在本研究中尚不清楚。
Objectives. The purpose of this study was to determine whether a relation exists between electrocardiographic (ECG) abnormalities and left ventricular wall motion in patients with subarachnoid hemorrhage.Background. Although ECG changes simulating acute myocardial infarction are frequently seen in patients with subarachnoid hemorrhage, their relation to left ventricular wall motion has not been established.Methods. Twelve patients with subarachnoid hemorrhage were classified according to the presence of ST segment elevation in at least two consecutive leads on admission: seven patients with ST segment elevation (group I) and five patients without ST segment elevation (group II). No patients had a previous history of heart disease. Left ventricular regional wall motion was evaluated by the centerline method. The mean (+/-SEM) duration from onset of subarachnoid hemorrhage to left ventriculography was 9 +/- 3 h in group I and 10 +/- 1 h in group II. Coronary angiography was performed to rule out wall motion abnormalities due to coronary artery disease while the ST segment was still elevated. Two-dimensional echocardiography was used to evaluate wall motion thereafter.Results. All patients in group I showed ST segment elevation in ECG leads V-4 to V-6. Wall motion of the left ventricular apex was significantly reduced in group I compared with group II (-2.48 +/- 0.41 vs. -0.45 +/- 0.72, p < 0.02). No patients showed organic stenosis or vasospasm, or both, of epicardial coronary arteries. Wall motion abnormalities decreased echocardiographically in all patients, but one patient in group I died in hospital at 2 or 3 weeks after the onset of subarachnoid hemorrhage, when the T wave was inverted in leads V-4 to V-6.Conclusions. These findings suggest that patients with subarachnoid hemorrhage and ST segment elevation may demonstrate transient corresponding regional wall motion abnormalities. The mechanism of neurogenic stunned myocardium was not clearly elucidated in the present study.