ST段持续抬高与室壁瘤、室壁运动异常与左室大小的关系

Relationship of left ventricular aneurysm, abnormal wall motion and size with ST segment elevation

目的 探讨Q波急性前壁心肌梗死患者心电图胸前导联ST段持续抬高与室壁瘤、室壁运动异常和左室大小的关系。方法 连续首次发病的 4 2例急性前壁心肌梗死患者 ,发病 2周时行 12导联心电图和超声心动图检查 ,分别测量心电图上胸前导联ST段抬高的程度 ,左室心内膜面积指数 (ESAi)和室壁运动异常区心内膜面积 (AWMa)和室壁运动异常得分。结果 在V2导联、抬高最大的导联上 ,室壁瘤和非室壁瘤组ST段抬高程度 ,差异无显著性 (p >0 0 5 )。V1至V6导联ST段抬高之总和室壁瘤组大于非室壁瘤组 (P <0 0 5 )。室壁瘤组的室壁运动积分明显高于非室壁瘤组 (P <0 0 1) ,但AWMa和ESAi,两组均无显著差别 (P >0 0 5 )。V2导联、抬高最大的导联和V1至V6导联ST段抬高之总和 ,室壁运动异常积分≥ 8分组显著高于室壁运动异常积分 <8分组 (P均 <0 0 1)。但入院时ESAi增大组和正常组之间无显著差别 (P >0 0 5 )。结论 梗死后 2周 ,心电图胸前导联持续抬高与左室前壁、心尖部和室间隔的运动异常程度有关 ,它并不能帮助明确诊断室壁瘤存在 。

Objective Echocardiography and electrocardiogram data in 42 patients with a first acute anterior Q wave myocardial infarction were analyzed to determine the relationship of ventricular aneurysm, abnormal wall motion and size with ST segment elevation. Methods Two weeks after myocardial infarction, all patients underwent two dimensional echocardiography for diagnosis of ventricular aneurysm. The wall motion score of each segment was graded. The endocardial surface area of left ventricle and abnormal wall motion area were calculated with an endocardial mapping technique. The ST segment elevation (mm) were also calculated at the same time. Results The ST segment elevation in V2 or the maximum ST segment elevation in V1 to V6 was of no significant difference between the patients with or without aneurysm(P>0 05), while the sums of ST segment elevation in V1 to V6 in patients with aneurysm were higher than those without aneurysm(P<0 01). However, the score of abnormal wall motion was higher in patients with aneurysm. The ST segment elevation in V2, the maximum ST segment elevation in V1 to V6 and the sums of maximum ST segment elevation in V1 to V6 in patients with a wall motion score ≥8 were higher than those with score<8(P<0 01), but the ST segment elevation was of no significant difference between the patients with enlarged and with normal endocardial surface area index(P>0 05). Conclusions Precordial ST segment elevation might be related to the extent of abnormal wall motion, but it does not clearly help to diagnose ventricular aneurysms, and neither is it related to left ventricular size.