左前降支狭窄部位及心肌梗死史对左心室功能的影响

Influence of history of myocardial infarction and location of isolated left anterior descending branch stenosis on left ventricular function

目的探讨单纯前降支(LAD)狭窄不同部位及有无心肌梗死(M I)史对左心室功能的影响。方法比较分析经冠状动脉造影证实的36例LAD近段狭窄患者、117例LAD中段狭窄患者和525例冠脉造影正常者的左室射血分数(LVEF)和左室舒张末压(LVEDP),并根据有无M I史分别比较。结果有M I史者,对照组、LAD近段组和中段组LVEF分别为(60.78±9.87)%、(52.29±9.41)%和(63.50±12.23)%,LAD近段组LVEF下降,与对照组和LAD中段组相比有统计学意义(P<0.05);无M I史者,3组LVEF分别为(68.31±10.74)%、(66.83±13.34)%和(67.5±10.33)%,无显著性差异(P>0.05)。任何组内有M I史者LVEF均明显低于无M I史者(P<0.05)。各组间节段室壁运动异常比例的比较基本同LVEF。LVEDP的平均值、LVEDP升高(大于12 mmHg)的发生率、造影前后LVEDP差值在各组间均无显著性差异(P>0.05)。结论心肌梗死可明显损害单纯LAD狭窄患者的左室收缩功能,在LAD近段狭窄时更为明显。

Objective To assess the impact of history of myocardial infarction （MI） and location of left anterior descending branch （LAD）lesion on left ventrieular function in patients with isolated LAD stenosis. Methods Thirty-six patients with isolated proximal LAD stenosis, 117 patients with isolated mid LAD stenosis and 525 patients with angiographieally nonsignificant coronary artery disease were analyzed in terms of such angio-hemodynamie parameters as the left ventrieular ejection fraction（LVEF） ,the left ventrieular end diastolic pressure（LVEDP） and the abnormal regional wall motion. Results Compared with the control group and the mid LAD group, the proximal LAD group significantly decreased in LVEF[ （52.29 ±9.41 ）% vs （60.78 ±9.87） % and （63.50±12.23） %, P 〈 0.05 ] in the presence of MI, while there was no difference in the absence of MI. Within each group,patients with MI were significantly lower than those without MI in LVEF（P 〈 0. 05）. The proportion of patients with abnormal regional wall motion presented as similar as LVEF. There was no statistical difference in LVEDP among different groups （P 〉 0.05 ）. Conclusion Left ventrieular systolic function is deteriorated progressively in cases with MI and proximal LAD stenosis.