前壁Q波心肌梗死后远期心功能减退的多因素回归分析

Multivariate Analysis on Long-term Left Ventricular Dysfunction in Patients with Q-wave Anterior Myocardial Infarction

【目的】探讨前壁Q波心肌梗死后远期心功能减退的相关因素。【方法】将102例病程大于或等于1年的前壁Q波心肌梗死患者分为左室射血分数<50%和≥50%两组,分析两组的临床特征、心肌梗死急性期和心肌梗死后12个月心电图特征及主要治疗措施。【结果】与≥50%组(59例)比较,<50%组(43例)病程稍长,糖尿病患病率高,QTCd增大,急性期远离性缺血和ST段持续性抬高≥2周发生率高,而急性期冠脉再通和12个月正向T波发生率低。Logistic回归分析显示,影响患者远期心功能的因素有远离性缺血、ST段持续抬高≥2周、12个月正向T波和冠脉再通。其中前两项是危险因素,后两项是保护因素。【结论】急性期远离性缺血和ST段持续抬高≥2周对前壁Q波心肌梗死患者远期心功能有不利影响,其中后者为重要危险因素。心肌梗死后12个月倒置T波未直立预示远期心功能减退,冠脉再通能改善患者远期心功能。

ObjectiveTo investigate the factors related to long-term left ventricular dysfunction in the patients with Q-wave anterior myocardial infarction (MI). MethodsOne hundred and two consecutive patients with Q-wave anterior myocardial infarction, whose courses after MI were at least one year, were divided into left ventricular ejection fraction (EF)< 50%group and EF≥50%group. EF< 50%group were compared with EF≥50%group about the clinical characteristics, the electrocardiogram features of acute stage and 12 months after MI and main treatments. ResultsCompared with the patients with EF≥50%(n=59), the patients with EF< 50%(n=43) had longer course, greater QTc dispersion and higher incidence of diabetes mellitus, remote ischemia and ST-segment persistent elevation (≥2 weeks), while lower incidence of patency of infarction-related coronary artery and normalization of negative T waves within 12 months after MI. Logistic analysis showed that risk factors affecting long-term left ventricular function were remote ischemia and ST-segment persistent elevation (≥2 weeks). Favorable factors were patency of infarction-related coronary artery and normalization of negative T waves within 12 months after MI. ConclusionRemote ischemia and ST-segment persistent elevation (≥2 weeks) are unfavorable factors to long-term left ventricular function in the patients with Q-wave anterior MI. Persistent T-wave inversions within 12 months after MI indicates poor cardiac function. Patency of infarction-related coronary artery at acute stage can improve long-term cardiac function of the patients.