心肌梗死后室壁瘤形成280例临床分析

Clinical analysis of 280 cases with left ventricular aneurysm after myocardial infarction

目的分析心肌梗死（MI）后室壁瘤形成的危险因素及临床特点。方法连续收集我院2003年3月至2007年9月心肌梗死后室壁瘤形成280例[平均年龄（64．2±10．4）岁]住院患者的临床资料，对其进行回顾性分析。结果广泛前壁、前侧壁心肌梗死249例（88．9％），室壁瘤形成位于心尖部269例（96．1％），二尖瓣反流124例（44．3％），207例（73．9％）左室收缩功能减退，左室射血分数（EF）≤40％。心肌梗死后有不同程度心绞痛、心力衰竭178例（63．6％），合并恶性室性心律失常24例（8．6％），左室附壁血栓54例（19．3％）。冠状动脉造影检查147例（48．2％，147／280），其中累及前降支117例（79．6％，117／147）。住院期间死亡11例（3。9％），死亡原囚主要为心力衰竭和恶性室性心律失常。结论前壁心肌梗死是室壁瘤形成的危险因素。心肌梗死后室壁瘤形成预后不良，罪犯血管为前降支。

Objective To analyze the clinical characteristics and the risk factors of left ventricular aneurysm （LVA） after myocardial infarction（ MI ）. Methods The clinical materials of 280 （mean age 64.2±10.4） consecutive patients with LVA after MI enrolled from March 2003 to September 2007 were retrospectively analyzed. Results The presence of LVA was strongly associated with large anterior wall M1 and accounted for 88.9%. LVA formation mostly localized at the apical segment （ 96.1% ）. Most of patients were diagnosed with marked changes in left ventrieular geometry and 124 （44.3%） had mitral regurgitation. 207 （73.9%） cases of the patients had significant left ventricuIar systolic dysfunction and left ventrieuIar ejection fraction less than or equal 40%. The majority of the patients had an identified angina peetoris or heart failure （New York Heart Association function class II - IV ）（63.6%）. 24 （8.6%）cases of the patients had malignant ventricle arrhythmia, and 54 （19.3%） had left ventrieular mural thrombus. 147 （48.2%） patients received coronary angiography, which showed 117 （79.6%）eases with anterior descending branch lesions. 11 （ 3.9% ） patients in the period of hospitalization died from the reasons linking to heart failure or malignant ventrieular arrhythmia. Conclusion Post-infarction left ventricular aneurysm has a poor prognosis. Anterior descending branch obstructive lesions, anterior myocardial infarction are the important risk factors of post-infarction left ventricular aneurysm.