心梗部位对超声多普勒左室舒张功能测定的影响

Influence of Infarct Sites on Estimation of Ultrasonic Doppler Left Ventricular Diastolic Function in Patients with Myocardial Infarction

目的 :观察心梗患者缺血部位不同对常规超声多普勒左室舒张功能检测指标的影响。资料与方法 :以核素心肌扫描显像为定位标准 ,将 84例急性、陈旧性心肌梗塞患者按缺血部位不同分成 :(1)前壁心梗 ,(2 )间壁心梗 ,(3 )下 (后 )壁心梗 ,(4 )侧壁心梗 ,(5 )广泛前壁 ,(6)前壁伴下壁及侧壁心梗 ,(7)心尖部室壁瘤形成 7组 ;观察了描述左室舒张功能的超声多普勒二尖瓣口血流速度指标 E/A比值和核素心血池造影左室峰值充盈率 LVPFR在各分组中的变化。结果 :缺血范围较局限的左室前壁、间壁及侧壁心梗组之间的 L VPFR测值无明显差别 ,分别为 (1.82± 0 .48)、(2 .0 7± 0 .79)、(2 .18± 0 .90 ) EDV/S,但多明显高于下 (后 )壁、广泛前壁、室壁瘤及左室壁多个部位缺血组 ,其 LVPFR分别为 (1.63± 0 .3 3 )、(1.2 2± 0 .68)、(1.45± 0 .43 )、(1.15± 0 .3 8) EDV/S,而后 4组之间的 L VPFR测值差别不显著 ;单有左室前壁、间壁缺血的心梗组的 E/A比值也高于左室下 (后 )壁、广泛前壁、多部位心肌缺血的心梗组 ,其 E/A比值分别为 1.17± 0 .3 1、1.0 9±0 .2 6、0 .78± 0 .2 8、0 .80± 0 .5 1、0 .81± 0 .3 1;除下 (后 )壁心梗组外 ,其它各组的 E/A比值与室壁瘤形成组差别不显著 ,后者的 E/A比值为 1.0 2± 0 .

Objective:To investigate the influence of different ischemic segments of left ventricular infarction on Doppler index in estimating the diastolic function of left ventricle. Materials and Methods: Based on the diagnosis of ECT, eighty four cases of acute and old myocardial infarction of LV were divided into 7 groups, including group of anterior wall infarction, group of interventricular septum infarction, group of inferior posterior wall infarction, group of lateral wall infarction, group of extensive anterior wall infarction, group of anterior and lateral (or inferior) wall infarction as well as group of ventricular aneurysm. The differences of Doppler E/A ratio of mitral orifice and LV peak flow rate of ECT among those cases were studied. Results: No statistical differences were found in the LVPFR values among the groups with limited infarct myocardium, such as anterior wall infarction, interventricular septum infarction and lateral wall infarction groups, however, the mean LVPFR values in the 3 groups were obviously higher than those among the other groups with inferior posterior wall infarction, extensive anterior wall infarction, ventricular aneurysm and anterior and lateral (or inferior) wall infarction. In the later 4 groups the LVPFR values had no much differences. The mitral E/A ratios of the group with anterior wall infarction or with interventricular septum infarction were also higher than those of the group with inferior posterior wall infarction or with extensive anterior wall infarction as well as with multi segment infarction. The mitral E/A ratios in the 6 groups, except for group of inferior posterior wall infarction, were not markedly lower than in group of ventricular aneurysm. Conclusion: Although the diastolic function of LV would often be impaired during the course of infarction, the changes of mitral E/A ratio or of LVPFR may depend on the numbers of ischemic segment, infarct size and infarct sites, which may be relative to compensatory movement of the non ischemic segments and may have influence on estimation of the extent of LV diastolic dysfunction in patients with myocardial infarction clinically.\;