【摘要】 目的应用超声心动图评价冠心病不同亚组和急性心肌梗死(AMI)不同部位、冠状动脉病变累及支数及其危险因素等对左室重塑和心功能的影响。方法研究对象包括冠心病患者251例,均经选择性冠状动脉造影狭窄≥75%和非冠心病患者96例。应用美国Acuson公司生产128XP/10超声仪测定心脏各项指标。观察冠心病不同亚组和AMI不同部位对左室重塑和功能的影响;分析血压、血脂、吸烟、血尿酸等危险因素和冠状动脉病变支数对AMI左室重塑和功能的影响。结果AMI、陈旧性心肌梗死和不稳定性心绞痛组患者均有不同程度地左室舒张末内径增大,左室质量增加、左室舒张末和收缩末容积增加,左室射血分数(LVEF)降低(P<005～00001)。其中,陈旧性心肌梗死以左心室质量增加为著,AMI以左室舒张末内径增大为著;在AMI中,前壁和复合部位(2个)对其影响更为显著。病变血管支数和AMI时的收缩压与LVEF值呈明显负相关,即病变血管累及越多、收缩压越高,LVEF值越低(P<005～0001)。原有高血压病的心肌梗死患者LVEF值明显降低,左室舒张末期内径和左室质量显著高于无高血压病组患者(P<0001)。结论冠心病不同亚组和心肌梗死不同部位对心脏左室重塑和功能影响不同。心肌梗死是造成左室重塑和心脏收缩功能减弱的主要原因,尤其是前壁和复合部位心肌梗死更为更多还原

【Abstract】 Objective To evaluate the effects of different styles of coronary heart disease (CHD) and different regions of acute myocardial infarction (AMI), its risk factors and branches of coronary stenosis on left ventricular remodeling and systolic function by applying echocardiography. Methods 251 patients with CHD and 96 without CHD (NoCHD) were verified by coronary angiography. CHD patients were divided into SA (stable angina pectoris, n =26), UA (unstable angina pectoris, n =53), AMI ( n =140) and OMI (old myocardial infarct, n =30) based on cTnT, cardiac enzyme and ECG. AMI patients were further divided into subgroups including Aa (acute anterior myocardial infarct, n =53), Ai (acute inferior myocardial infarct, n =54) and Aa+Ai ( n =33) based on ECG. Cardiac parameters [IVSd (end diastolic interventricular septum thickness), LVd (end diastolic left ventricular internal diameter), LM (left ventricular mass), EDV (end diastolic left ventricular volume), ESV (end systolic left ventricular volume) and EF (left ventricular ejection fraction)] were measured by ACUSON 128XP/10 echocardiography. The effluence of the involved branches of coronary stenosis, blood pressure, blood lipids, glucose and etc on LVEF and LVd was analyzed in patients with AMI. Results EDV, ESV and EF in patient with AMI, OMI and UA were significantly changed ( P <0 05～0 0001), especially in those with AMI. LM was mainly increased in patients with OMI ( P <0 01) and LVd was mainly increased in patients with AMI. EF was significantly decreased and EDV, ESV, LM and LVd were remarkably increased in patients with Aa and Aa+Ai. With the multiple regression analysis by SPSS software, we found the branches of involved coronary stenosis and systolic blood pressure after AMI were negatively related to LVEF in patients with AMI, while there was no significant relationship between other factors and LVEF. LVEF was significantly decreased, and LVd and LM were remarkably increased in patients with hypertension before AMI, compared to patients without hypertension ( P <0 001). Conclusions Effects of different styles of CHD and different regions of AMI on left ventricular remodeling and cardiac function are different. Myocardial infarction is one of the most important causes of left ventricular remodeling and cardiac dysfunction, especially in AMI patients with Aa and Aa+Ai. Multiple vessel stenosis and systolic blood pressure mainly affected LVEF in patients with AMI, reduced LVEF. Antecedent hypertension might be a main reason of bringing about cardiac remodeling and dysfunction.更多还原