急性心肌梗死早期二尖瓣血流减速时间预测左室扩大的价值

Predictive value of early mitral deceleration time in left ventricular volume dilation in patients with acute myocardial infarction

目的 探讨急性心肌梗死 (AMI)患者早期二尖瓣血流减速时间预测左室扩大的价值。方法 行直接经皮冠状动脉腔内球囊成形 (PTCA)的AMI患者 34例 ,于梗死后第 7、30、6 0、90d行二维和多普勒超声心动图检查。以左室容积增大 2 0 %以上为左室扩大。按E峰减速时间 (DT)长短分为两组 ,DT≤ 130ms的 13例为A组 ,DT >130ms的 2 1例为B组。结果 AMI后 90d ,左室舒张末期容积指数 (LVEDVI)、左室收缩末期容积指数 (LVESVI)A组明显大于B组 (EDVI 6 7.5 3vs 5 0 .99,P =0 .0 40 ;ESVI 36 .0 1vs 2 0 .99,P =0 .0 48) ,左室射血分数 (LVEF)A组明显小于B组 (5 0 .74%vs 6 1.2 4% ,P =0 .0 2 0 )。左室扩大者 14例 ,A组 10例 ,B组 4例 ,两组有明显差异 ,(P =0 .0 4)。结论 AMI患者早期二尖瓣血流减速时间缩短预示梗死恢复期左室扩大。

Objective To evaluate the predictive value of early mitral deceleration time (DT) in left ventricular volume dilation in patients with acute myocardial infarction(AMI).Methods Two dimensional and Doppler echocardiographic examinations were performed at days 7,30, 60,90 after the onset of AMI in 34 patients with first AMI who underwent direct PTCA successfully.Left ventricular end diastolic volume and left ventricular end systolic volume were measured and corrected as end diastolic volume index (EDVI) and end systolic volume index (ESVI), and left ventricular ejection fraction (LVEF) was calculated with Simpson's rule. Left ventricular volume expansion >20% was defined as left ventricular volume dilation. Patients were divided into two groups according to mitral deceleration time at day 7 after AMI. Group A: DT≤130 ms (n=13) and group B: DT>130 ms (n=21).Results EDVI, ESVI and LVEF were nosignificant difference between group A and group B at day 7, 30 and 60 after AMI.At day 90 after AMI, EDVI and ESVI were significantly larger and LVEF were significantly lower in group A than those in group B (EDVI: 67.53 vs 50.99 , P= 0.040 ; ESVI: 36.01 vs 20.99 ,P= 0.048 ; LVEF: 50.74% vs 61.24% , P= 0.020 ). There were 14 cases with LV volume dilation, 10 of these cases were in group A (10/13) and 4 cases were in group B (4/21), there was significant difference between the two groups (P= 0.04 ). Conclusions Shortening of early mitral deceleration time in patients with acute myocardial infarction suggests left ventricular volume dilation and left ventricular contractile dysfunction.