急性心肌梗死后T波演变与左心功能的关系

Observation of changes of the T wave after acute myocardial infarction

目的探讨ST段抬高型心肌梗死由急性期到慢性期T波的演变规律及其与左心功能的关系。方法选择急性前壁心肌梗死患者142例。据心电图T波的形态分为T波永久倒置组、T波持续直立组和T波演变组。据T波倒置深度分为浅倒组、中倒组和深倒组。记录各组T波振幅、超声心动指标和冠状动脉造影结果。结果①在AMI后慢性期T波演变组较T波永久倒置组和T波持续直立组LVEF偏高,LVEDD和室壁运动指数(WMI)偏低,主要心脏不良事件发生率低。②3个月直立组左心功能优于6个月和12个月直立组。③T波深倒组左心功能好于浅倒组和中倒组,且其无复流发生率低,主要心脏不良事件少。结论T波极性正常化的早晚及倒置的深度,可以评估左心功能、判断预后。

Objection To study the relationship between the left ventricular function and regularity changed of T waves from the acute phase to the chronic phase in patients with ST segment elevate myocardial infarction （STEMI）. Methods We studied 142 patients of acute anterior MI with ST segment elevate .According to the shape of T waves,we divided the persistent negative-T-waved group, the persistent positive-T-waved group and the changed-T-waved group.According to the depth of T waves inversion,we divided the superficial negative- T-waved（SNT）, inter negative-T-waved （INT） and deep negative-T-waved group（DNT）. The amplitude of Twave, ultra echocardiography and coronary angiography were recorded in these patients, and observed major adverse cardiac event（MACE）.Results LV ejection fraction was higher in changed-T-waved group than those in the persistent positive-T-waved and the persistent negative-T-waved group, but LV dimension and Wall motion index were lower in the chronic stage. The incidence of MACE was higher in persist positive-T-waved group.The left Ventricular function was better in the 3M- positive T-wave subgroup than 6M- and 12M-positive T-wave subgroup.LV function was better in DNT than MNT and SNT. The incidence of no-reflow was lower in patients with the deep negative-T-waved group. Conclusion The time span required for negative T waves＇normalization and depth of inversion in patients with STEMI can be used to assess the degree of LV dysfunction, and rate of the coronary no reflow is the lowest.