心电图墓碑样ST段抬高与AMI早期左室重构的关系

The relationship between tombstoning of ST segment elevation in ECG and early-term reconsitution of left ventricule after AMI

目的 评价墓碑样ST段抬高对AMI早期左室重构的影响。方法 对 12 5例初发的AMI,按梗死部位分为前壁和下壁组 ,根据ECG的ST段变化再分为墓碑样抬高亚组和非墓碑样抬高 (通常型 )亚组。在起病第四周用超声心动图检查室壁运动情况 ,测量并计算左室收缩末期容积(ESV) ,舒张末期容积 (EDV) ,每搏输出量 (SV)和射血分数(EF) ,并与对照组比较。结果 在前壁梗死墓碑样抬高组EDV =(16 8 19± 11 0 3)mL ,ESV =(116 93± 19 31)mL ,SV =(5 1 2 6± 7 94 )mL ,EF(30 4 7± 12 37) % ,P <0 0 1;通常组EDV =(133 4 3± 5 73)mL ,ESV =(6 6 92± 9 0 7)mL ,SV =(6 6 5 1± 9 7)mL ,EF =(49 84± 13) %。在下壁梗死 ,墓碑样抬高组EDV =(14 3 0 5± 15 4 7)mL ,ESV =(88 12± 14 75 )mL ,SV =(5 4 93± 12 0 9)mL ,EF =(38 39± 10 8) % ,P <0 0 5。通常组EDV =(12 8 78± 12 2 5 )mL ,ESV =(5 7 5 1± 8 0 4 )mL ,SV=(71 2 7± 4 4 7)mL ,EF =(5 5 34± 9 3) %。墓碑样抬高组较通常组更多发生室壁瘤。

Objective The aim of this study was to assess the significance of tombstoning of ST segment elevation in ECG in the predication of the reconstitution of left ventricule in the early term after AMI. Method 125 patients first AMI were divided into anterior myocardial infarction group and inferior myocardial infarction group, each group was divided into tombstoning elevation subgroup and non tombstoning elevation (general) subgroup according to the ST segment change in ECG separately. The left ventricular end diastolic volum (EDV), end systolic volum (ESV), condition of left ventricular wall motion, SV and EF were analysised by two dimensional echocardiography four weeks after AMI. Result The acute anterior myocardial infarction, tombstoning elevation subgroup showed EDV=(168.19±11.03)mL, ESV=(116.93±19.31)mL,SV=(51.26±7.94)mL,EF=(30.47±12.37)% general subgroup EDV=(133.43±5.73)mL,ESV=(66.92±9.07)mL,SV=(66.5±9 70)mL,EF=(49.84±13)%;( P <0.01); The acute inferior myocardial infarction, tombstoning elevation subgroup showe EDV=(143.05±15.47)mL, ESV=(88 12±14 75) mL,SV=(54.93±12.09)mL,EF=(38.39±10.8)% general subgroup EDV=(128 78±12.25)mL,ESV=(57 51±8.04)mL,SV=(71.27±4.47)mL,EF=(55.34±9.3)%,( P <0.05); There are more patients presented ventricular aneurysm in tombstoning group. Conclusion There were significant relation between tombstoning of ST segment elevation in ECG and early term reconstitution of left ventricule after AMI.