心肌梗死并心功能不全患者冠状动脉介入治疗的作用

Effect of percutaneous coronary intervention on cardiac systolic function and remodeling of the left ventricle in patients with myocardial infarction

目的 :评价心肌梗死 (MI)并左心功能不全患者经皮冠状动脉介入术 (PCI)对左心收缩功能和左心室重构的作用。方法 :5 2例MI并左心功能不全患者 ,急性心肌梗死 (AMI) 30例 ,陈旧性心肌梗死 (OMI) 2 2例 ,行经皮腔内冠状动脉成形术加支架术治疗 ,术后随访 3个月 ,超声心动图测定左室舒张末内径 (LVEd)、左心房内径(LAd)、左室舒张末容积 (LVEDV)、左室收缩末容积 (LVESV)、左室射血分数 (LVEF)和左室短轴缩短率 (LVFS) ,比较治疗前后各参数的变化。结果 :PCI治疗后LVEd、LAd、LVEDV、LVESV较治疗前均明显减少 (均P <0 .0 1)、LVEF和LVFS明显增高 (P <0 .0 1) ,尤以AMI组明显 ,并且冠状动脉血运重建的时间越早 ,心功能恢复越好。结论 :MI并左心功能不全患者尽早PCI治疗可明显改善左心室收缩功能 ,部分阻抑左心室重构。

Objective:To assess the effect of percutaneous coronary intervention (PCI) on cardiac systolic function and remodeling of the left ventricle in patients with myocardial infarction (MI)over a 3-month period.Method:Fifty-two cases of MI with left ventricular dysfunction, including 30 acute MI (AMI) and 22 old MI (OMI) patients were treated by percutaneous transluminal coronary angioplasty (PTCA) and stent. Three months follow-up was conducted after PCI. The left ventricular end diastolic diameter (LVEDd), left atrial diameter(LAd), left ventricular end diastolic volume(LVEDV), left ventricular end systolic volume(LVESV), left ventricular ejection fraction(LVEF) and the left ventricular fractional shortening (LVFS) indexes were measured by Doppler echocardiography and compared the parameters pre-and post-PCI. Result:The LVED, LAD, LVEDV, LVESV indexes were significantly reduced (P< 0.001)after PCI than those befere PCI. LVEF and LVFS indexes were increased apparently (P< 0.001), especially in the AMI group. The earlier the revascularization of coronary artery, the better the cardiac function recovery.Conclusion: The AMI patients with left ventricular dysfunction should be treated with PCI as soon as possible which can improve the left ventricular systolic function apparently and partly impede the remodeling of the left ventricle