急性心肌梗死后二尖瓣反流与左心室大小和功能的相关分析

Relationship study of mitral regurgitation and function of left ventricle in patients with acute myocardial infarction

目的探讨急性心肌梗死（AMI）二尖瓣反流（MR）患者左心室功能与远期预后的关系。方法入选143例AMI患者，平均入院5d内行超声心动图检查，检测MR情况、左室舒张期末内径（LVEDD）、左室收缩期末内径（LVESD）、左房内径（LAD）、左室射血分数（LVEF）、E／A比值。根据LVEF大小将患者分为2组（≥50％组和〈50％组）；随访的中位数时间为432d，观察两组心力衰竭、再发心肌梗死、再发心绞痛、心因性死亡等心血管事件的发生率与LVEF的相关性。结果AMI患者MR发病率73．4％。MR的发生及程度与Killip分级、LVEF值、LVEDD、LVESD、LAD、E／A比值等相关。左心室大小和功能与AMI后心血管事件显著相关。生存分析显示，AMI后MR患者LVEF〈50％是远期死亡的独立危险因素（P〈0．01）。结论AMI后基线水平MR的严重程度与左室功能和大小显著相关，左室功能恶化是远期死亡的显著预测因子。

Objective To study the relationship between mitral regurgitation（MR） and the size and function of left ventricluler in patients with acute myocardial infarction （AMI）. Methods 143 patients with AMI were divided into LVEF≥50% and LVEF〈50% groups according to the results of echocardiography. The degree of MR, LVEDD, LVESD, LAD, LVEF, and E/A ratio were recorded. Median term of follow-up was 432 days. The relationship of cardiovascular events （heart failure, re-MI, re-angina and cardiac death） and LVEF was analyzed. Results The prevalence of MR in AMI patients was 73.4%. The prevalence and degree of MR were significantly correlated with Killip grading, value of LVEF, LVEDD, LVESD, LAD. The size and function of LV was significantly correlated with cardiovascular events in AMI patients. The survival analysis showed that LVEF〈50% was the independent predictor for the long-term mortality in AMI patients with MR （P〈0.01）. Conclusion The degree of MR is significantly correlated with the size and function of LV, and the deteriorate function of LV is the significantly predictor for the long-term mortality.