急性心肌梗死首次发作后左室非同步运动对左室功能早期改变的影响

Impact of left ventricular dyssynchrony on early left ventricular function after first acute myocardial infarction

目的：探讨急性心肌梗死患者左室非同步运动是否可作为左室射血分数（LVEF）降低的一个独立影响因素。方法急性心肌梗死首次发作患者（梗死组）47例，经皮冠状动脉介入治疗术后2～4 d，实时三维超声心动图观测左室舒张末容积（LVEDV）、左室收缩末容积（LVESV）、LVEF及左室非同步指数（SDI）。体检健康者35例作为对照组。结果与对照组比较，梗死组LVESV、SDI增高，LVEF减低（均P＜0．01），SDI与LVEF呈负相关（r＝-0．948，P＜0．01）。多重线性回归分析，与LVEF相关的因素有体质量、心电图ST段改变、冠状动脉病变条数、LVEDV、LVESV及SDI。结论患者体质量、心电图ST段异常、冠状动脉病变条数、LVEDV、LVESV及SDI均可作为可作为评估、预测左室功能的重要指标，尤以心电图ST段异常及SDI影响较大。

Objective To explore whether the left ventricular dyssynchrony in patients with acute myocardial infarction can be an independent influence factor for the decrease of left ventricular ejection fraction（LVEF）. Methods Forty-seven patients with acute myocardial infarction in the first attack.Clinical manifestations,ECG,myocardial enzymes tests and coronary angiographic findings are in line with the diagnosis of acute myocardial infarction. Real-time three-dimensional echocardiography was used to observe the left ventricular systolic function and left ventricular dyssynchrony systolic of 2~4 days after PCI. Other 35 healthy volunteers of cases were used as normal control group. Results Compare with control group,SDI in acute myocardial infarction group was significantly higher（1.41%＆#177;0.40%vs. 6.54%＆#177;1.80%,P〈0.01）. The difference between the two groups was statistically significant.SDI and LVEF was significantly negatively correlated（r=0.948,P＆lt;0.01）.Can be seen from the multiple linear regression analysis,a number of influencing factors associated with LVEF.The main factors have weight,ECG ST segment changes,coronary artery lesions,left ventricular end-diastolic volume,left ventricular end-systolic volume and SDI. Conclusion The body weight,ECG ST-segment abnormalities,number of lesions of coronary artery,left ventricular end-diastolic volume,end-systolic volume and left ventricular systolic dyssynchrony can be used as indicators for evaluating and predicting left ventricular function.