急性ST段抬高性前壁心肌梗死患者的右心室功能分析

Right Ventricular Function in Patients With Acute ST Segments Elevation Anterior Myocardial Infarction

目的:评价急性前壁ST段抬高性心肌梗死直接经皮冠状动脉成形术(PCI)患者的右心室收缩和舒张功能变化。方法:分析46例急性前壁ST段抬高性心肌梗死患者[前降支近端完全闭塞者24例(前降支近端闭塞组),前降支远端急性闭塞者22例(前降支远端闭塞组)]直接PCI和35例冠状动脉造影"正常"患者(对照组)的临床、冠状动脉造影和心电图资料。采用二维心脏超声分别测定入选患者的右心室舒张末期容积(RVEDV),右心室收缩末期容积(RVESV),右心室射血分数(RVEF),平均肺动脉压(MPAP),左心室舒张末期容积(LVEDV),左心室收缩末期容积(LVESV),左心室射血分数(LVEF)和心脏指数(CI)。结果:与对照组相比,前降支远端闭塞组的平均肺动脉压无显著性差异(P>0.05),而右心室舒张末期容积和收缩末期容积增大,右心室射血分数降低;左心室舒张末期容积和收缩末期容积增加,左心室射血分数、心脏指数减低(P均<0.01)。与前降支远端闭塞组比较,前降支近端闭塞组的左心室舒张末期容积和收缩末期容积增加(P<0.01),心脏指数和左心室射血分数减少(P<0.01),右心室舒张末期容积收缩末期容积和平均肺动脉压增加(P<0.05～0.01),右心室射血分数降低(P<0.01)。多元线性回归分析表明前降支近端闭塞与右心室射血分数降低(R2=0.38,P<0.01)、右心室舒张末期容积增加(R2=0.410,P<0.01)有较好的相关性。2周后,前降支近端和远端闭塞组的右心室舒张末期容积、右心室收缩末期容积、平均肺动脉压和右心室射血分数无明显差异,而前降支近端闭塞患者的左心室舒张末期容积和收缩末期容积增大,左心室射血分数和心脏指数较低(P均<0.01)。结论:提示前降支近端闭塞可能伴右心室前壁部分心肌梗死导致右心室收缩和舒张功能障碍。

Objective ： The present study investigated the right ventrieular function in acute anterior ST segment elevation myocardial infarction patients undergoing primary pereutaneous eoronary intervention （PCI）. Methods ：Clinical presentations, coronary, angiography（CAG）, and electrocardiography data of 46 patients with acute anterior ST segments elevation myocardial infarction and 35 patients with normal CAG were analyzed. Right ventricular end-diastolic volume （RVEDV）, right ventricular end-systolic volume （RVESV）, right ventricular ejection function（ RVEF）, mean pulmonary artery pressure（ MPAP）, left ventricular end-diastolic volume（ LVDEV）, left ventricular end-systolic volume（ LVESV）, left ventricular ejection function（ LVEF）, and cardiac index（CI） were measured in all patients. Results ： There were no significant differences of MPAP in patients with distal occlusion of left anterior descending coronary （P 〉 0. 05 ） , but RVEDV, RVESV, LNEDV, LVESV were increased（ P 〈 0. 01 ）, and RVEF, LVEF, and CI were decreased in patients of LAD distal occlusion in comparison with control group（P 〈0.01 ）. However, LVEDV, LVESV, RVEDV, RVESV, MPAP were increased （P 〈0. 05 -0. 01 ） , and RVEF, LVEF, and CI were decreased in patients with LAD proximal occlusion （ P 〈 0. 01 ） in comparison with the patients with LAD distal occlusion. Multiple linear regression analysis showed LAD proximal occlusion was a significant determinant for both RVEF （ R^2= 0. 38, P 〈 0. 01 ） and RVEDV （ R^2 = 0. 410, P 〈 0. 01 ）. There were no significant difference in RVEDV, RVESV, MPAP, and RVEF between LAD proximal occlusion group and LAD distal occlusion group（P 〈 0. 05）. The patients with LAD proximal occlusion had higher LVEDV and LVESV, and lower LVEF and CI than the patients with LAD distal occlusion（ P 〈0. 01 ）. Conclusion： The results suggested that proximal occlusion of LAD accompanied by infarction of anterior right ventricular wall might lead to impairment of right ventricular diastolic and systolic function.