心肌梗死对慢性完全闭塞病变血运重建后心功能的影响

Assessment of recanalization of chronic total occlusions on left ventricular function in patients with or without previous myocardial infarction by real-time three-dimensional echocardiography

目的应用实时三维超声心动图（RT3DE），根据既往有无心肌梗死（以下称心梗）病史，分组评价冠状动脉慢性完全闭塞病变（CTO）患者血运重建前后心功能的变化。方法选择血运重建成功CTO患者32例，根据血运重建的闭塞血管供血范围既往有无心肌梗死分为2组。所有患者术前、术后6周均行RT3DE测量左室射血分数（LVEF）。结果RT3DE测量，非心梗患者术后LVEF由（49．9±7．2）％增加至（57．5±8．7）％（P〈0．05）；心梗患者LVEF由（48．6±6．1）％增加至（50．1±6．4）％（P〉0．05）。结论RT3DE可准确、方便地评价CTO患者的心功能。对既往无陈旧性心梗病史的CTO患者成功地进行再血管化治疗，可以提高左室心功能；而有陈旧性心梗病史的CTO患者心功能改善不明显。

Objective To assess the changes of left ventricular ejection fraction （LVEF） after successful revaseularization of chronic total occlusions （CTO） with or without previous myocardial infarction（MI） by real-time three-dimensional echocardiography （RT3DE）. Methods 32 patients with a successfully revaseularizated CTO were included in the present prospective study. The patients were divided into group 1 without previous MI and group 2 with previous MI in the territories of total occlusion vessel. In all patients, LVEF was determined by RT3DE at baseline and after six weeks. Results In group 1 , the values of LVEF increased from （49.9±7.2）% to （57.5±8.7）%（P〈0.05）. In 2 patients,the evolution of LVEF increased,but not significantly, from （48.6±6.1）% to （50.1±6.4）%（P〉0.05）. Conclusion Left vcntricular function in patients with CTO can be feasibilitly and accurally evaluated by RT 3DE. The influence of revascularization of CTO on the improvement of left ventricular function is different between MI and non-MI patients.The left ventricular function does not improve in MI patients, but improves significantly in the non-MI patients.