急性心肌梗死后左心室重构与室性心律失常的关系

The relationship between the left ventricular remodeling and ventricular arrhythmias after acute myocardial infarction

目的探讨急性心肌梗死(AMI)后左心室(左室)重构与室性心律失常之间的关系。方法选取84例AMI患者,随机分为两组,A组接受ACEI治疗,B组不接受ACEI或ARB类药物治疗。随访观察梗死后左室收缩末期容积(LVESV),左室舒张末期容积(LVEDV)、左室重量(LVM)和左室射血分数(LVEF)与室性心律失常发生率之间的关系。结果AMI1年后A组LVESV小于B组,LVEF大于B组。A、B两组的LVESV随病程延长而增大,LVEF随病程延长而减低。AMI2周内发生室性心律失常组的LVM高于未发生组。AMI6个月和一年后发生心律失常组的LVEDV、LVESV和LVM高于未发生组,未发生组的LVEF高于发生组。发生室性心律失常组的LVEDV、LVESV和LVEF在三个时间点间差异及未发生室性心律失常组的射血分数在三个时间点间差异均有显著性(P<0.05)。室性心律失常在AMI2周内与LVM;6个月后与LVESV和LVM;1年后与LVEDV和LVESV密切相关。结论AMI后左室重构是引起室性心律失常重要基质。

Objective To observe the relationship between the left ventricular remodeling and ventricular arrhythmias after acute myocardial infarction （AMI）. Methods Eighty-four patients with AMI were randomized into group A and B. ACEI treatment was conducted in group A and not in group B. Left ventricular end-diastolic volume （ LVEDV）, end-systolic volume （LVESV） , mass （ LVM ）, ejection fraction （LVEF）,and ventricular arrhythmias prevalence were observed during 1 year follow-up. Results The LVESV of group A was less than group B, and LVEF of group A was bigger than group B at 1 year. During follow-up,the LVESV and LVEF of beth two groups were gradually increase and decrease,respectively. The LVM of arrhythmia group was bigger than non-arrhythmia group within 2 weeks. At 6 months and 1 year, the LVEDV, LVESV, and LVM of arrhythmia group were bigger than non-arrhythmia group, and the LVEF of arrhythmia group was less than non-arrhythmia group. Among three time points, significant differences were shown in the LVEDV,LVESV,and LVEF of arrhythmia group,and were shown in LVEF of non-arrhythmia group. Ventricular arrhythmia was closely associated with the LVM within 2 weeks,with the LVESV and LVEF at 6 months,and with LVEDV and LVESV at 1 year. Conclusions Postinfarction left ventricular remodeling is an essential substrate of ventricular arrhythmias.