FREQUENCY OF ACUTE AND HEALED MYOCARDIAL INFARCTS IN FATAL CARDIAC AMYLOIDOSIS

穿壁(超过内侧一半的受累部位 心肌壁)左室壁坏死或纤维化最多 常为重度(超过75%的横截面积) 因一个或多个主要动脉粥样硬化斑块而变窄 心外膜冠状动脉。也可能发生心肌梗死。 心外膜冠状动脉无明显狭窄 几种情况，包括肥厚性心肌病，扩张 心肌病，左或右肺流出道梗阻，以及 冠状动脉起源或走向的异常。另一个条件 与无明显狭窄的心肌梗死相关 1支或1支以上的心外膜冠状动脉是心脏的 淀粉样变性。61例尸检患者，年龄21~97岁(平均) 心脏淀粉样变性严重到足以导致心脏功能不全 在过去的28年里，有3人(5%)在本实验室研究过 左侧穿透性室壁坏死5例(8%) 室壁，53例(87%)无坏死或纤维化。 1例有坏死，3例有纤维化，9例两者都没有。 坏死性非纤维化和1支或1支以上心外膜冠状动脉 因动脉粥样硬化斑块而严重狭窄。两名患者患有 坏死和2例纤维化，加上44例两者都不是，没有 心外膜冠状动脉狭窄75%以上。 动脉粥样硬化斑块的截面积。

Transmural (involvement of more than the inner one-half of the myocardial wall) left ventricular necrosis or fibrosis is most often secondary to severe (more than 75% cross-sectional area) narrowing by atherosclerotic plaques of 1 or more of the major epicardial coronary arteries. Myocardial infarction also may occur without significant narrowing of an epicardial coronary artery in several conditions, including hypertrophic cardiomyopathy, dilated cardiomyopathy, left or right ventiruclar outflow obstruction, and anomalies of coronary arterial origin or course. Another condition associated with myocardial infarction without significant narrowing of 1 or more of the epicardial coronary arteries is cardiac amyloidosis. Of 61 necrospy patients aged 21 to 97 years (mean 64) with cardiac amyloidosis severe enough to cause cardiac dysfunction studied in this laboratory during the past 28 years, 3 (5%) had transmural necrosis and 5 (8%) had transmural fibrosis of the left ventricular wall, and 53 (87%) had neither necrosis nor fibrosis. One patient with necrosis, 3 with fibrosis, and 9 with neither necrosis nor fibrosis and 1 or more epicardial coronary arteries severely narrowed by atherosclerotic plaque. Two patients with necrosis and 2 with fibrosis, plus 44 with neither, had no epicardial coronary artery narrowed more than 75% in cross- sectional area by atherosclerotic plaque.