急性心肌梗死并缺血性二尖瓣返流的临床特征分析

Analysis of Clinical Characteristics of Acute Myocardial Infarction Complicated With Ischemic Mitral Regurgitation

目的:探讨初发急性心肌梗死并缺血性二尖瓣返流(IMR)的临床特征。方法:对初发AMI363例患者的临床资料进行回顾性分析,根据心脏超声检查和二尖瓣返流情况分为2组,二尖瓣返流组119例,无二尖瓣返流组244例,比较2组临床特征、左房直径、左室舒张末期直径、左室收缩末期直径、左室射血分数和心血管事件发生率。结果:单因素分析结果显示年龄、性别、吸烟、Killip分级、下壁心肌梗死、β受体阻滞剂和ACEI/ARB应用、直接冠状动脉介入治疗、主动脉内球囊反搏应用、左房直径、左室舒张末期直径、左室收缩末期直径、左室射血分数、房颤发生率及住院病死率2组资料比较差异有统计学意义。多因素分析显示二尖瓣返流与年龄(P<0.01)、左室舒张末期直径、左室收缩末期直径(P<0.05)及早使用β受体阻滞剂和ACEI/ARB、直接冠状动脉介入治疗密切相关(P<0.01)。结论:AMI并IMR多见于老年患者,与左室直径大小密切相关,及早应用β受体阻滞剂和ACEI/ARB,直接冠脉介入治疗可能会减少二尖瓣返流的发生。

Objectives： To explore the clinical characteristics of primary acute myocardial infarction （ AMI） complicated with ischemic mitral regurgitation （ IMR） . Methods： Clinical data of 363 cases with primary AMI were analyzed retrospectively. The patients were divided into two groups according the results of mitral regurgitation （ MR） diagnosed by echocardiography： 119 cases with （ MR） and 244 cases without MR. The clinical characteristics,left atrial diameter （ LAD） , left ventricular end-diastolic diameter （ LVEDD） ,left ventricular end-systolic diameter （ LVESD） ,the left ventricular ejection fraction （ LVEF） as well as the incidences of cardiovascular event were compared among two groups. Results： Univariate analysis revealed that there were statistical differences between two groups in respect of age,sex,smoking,Killip class, inferior AMI,and treatment with β-blockers and angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker （ ACEI/ARB） ,primary percutaneous coronary intervention （ PCI） ,application of intra-aortic balloon pump,LAD, LVEDD and LVESD,LVEF,incidence of atrial fibrillation,and in-hospital mortality. Multivariate logistic regression revealed that MR was closely correlated with age（ P 0. 01） ,LVEDD and LVESD （ P 0. 05） ,early treatment with β-blockers and ACEI/ARB,primary PCI（ P 0. 01） . Conclusions： AMI complicated with IMR is mostly seen in elderly patients,and is closely related to LVD. Early treatments with β-blockers,ACEI/ARB ,and primary PCI may reduce the occurrence of MR.